Provider Demographics
NPI:1093727463
Name:PARNASSUS HEIGHTS PODIATRY GROUP
Entity Type:Organization
Organization Name:PARNASSUS HEIGHTS PODIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:415-759-2014
Mailing Address - Street 1:1 SHRADER ST STE 510
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1034
Mailing Address - Country:US
Mailing Address - Phone:415-759-2014
Mailing Address - Fax:415-759-2015
Practice Address - Street 1:1 SHRADER ST STE 510
Practice Address - Street 2:STE 4A
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1034
Practice Address - Country:US
Practice Address - Phone:415-759-2014
Practice Address - Fax:415-759-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAT10912213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACJ8755OtherRR MEDICARE GROUP #
CAAR850AMedicare PIN
CA4581020001Medicare NSC
CAZZZ22699ZMedicare PIN