Provider Demographics
NPI:1467521484
Name:KAISER, JONATHAN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:KAISER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1083 VINE STREET
Mailing Address - Street 2:SUITE #852
Mailing Address - City:HEALDSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:95448-4830
Mailing Address - Country:US
Mailing Address - Phone:415-246-9043
Mailing Address - Fax:415-381-7503
Practice Address - Street 1:1083 VINE STREET
Practice Address - Street 2:SUITE #852
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-4830
Practice Address - Country:US
Practice Address - Phone:415-246-9043
Practice Address - Fax:415-381-7503
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42113174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist