Provider Demographics
NPI:1093903205
Name:SOMA ORTHOPEDICS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SOMA ORTHOPEDICS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:ATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-550-1474
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-1230
Mailing Address - Country:US
Mailing Address - Phone:415-642-0707
Mailing Address - Fax:415-550-1566
Practice Address - Street 1:1580 VALENCIA ST
Practice Address - Street 2:SUITE 703
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-4423
Practice Address - Country:US
Practice Address - Phone:415-642-0707
Practice Address - Fax:415-550-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79161207LP2900X
CAG65707207X00000X
CAA90204208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6358250001Medicare NSC
CAZZZ06554ZMedicare PIN