Provider Demographics
NPI:1225116569
Name:KASALAJTIS, LISA B (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:B
Last Name:KASALAJTIS
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:1199 BUSH STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:415-673-7600
Mailing Address - Fax:415-673-8065
Practice Address - Street 1:1199 BUSH STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-673-7600
Practice Address - Fax:415-673-8065
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2008-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA79227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A792270Medicaid
P00244625OtherRR MEDICARE
I19209Medicare UPIN
CA00A792270Medicaid