Provider Demographics
NPI:1225119704
Name:SAN FRANCISCO UROLOGY MED GR
Entity Type:Organization
Organization Name:SAN FRANCISCO UROLOGY MED GR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-922-3255
Mailing Address - Street 1:2186 GEARY BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3455
Mailing Address - Country:US
Mailing Address - Phone:415-922-3255
Mailing Address - Fax:415-922-2527
Practice Address - Street 1:2186 GEARY BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3455
Practice Address - Country:US
Practice Address - Phone:415-922-3255
Practice Address - Fax:415-922-2527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89570Medicare UPIN
CAA55417Medicare UPIN
CAA51925Medicare UPIN
CAH46360Medicare UPIN
CAZZZ31141ZMedicare PIN