Provider Demographics
NPI:1194229187
Name:KOPP, ZOE
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:KOPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 DIVISADERO ST.
Mailing Address - Street 2:CLINIC 1 & 2
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:415-353-7900
Mailing Address - Fax:415-353-2405
Practice Address - Street 1:1545 DIVISADERO ST.
Practice Address - Street 2:CLINIC 1 & 2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-353-7900
Practice Address - Fax:415-353-2405
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA165963207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program