Provider Demographics
NPI:1477639128
Name:SHUSTERMAN, DENNIS JAY (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JAY
Last Name:SHUSTERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 POST ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3465
Mailing Address - Country:US
Mailing Address - Phone:415-885-7580
Mailing Address - Fax:415-771-4472
Practice Address - Street 1:2330 POST ST
Practice Address - Street 2:SUITE 460
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3465
Practice Address - Country:US
Practice Address - Phone:415-885-7580
Practice Address - Fax:415-771-4472
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG405102083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
325420OtherINTERNAL ID-MOTOR VEHICLE ID
WA8395717Medicaid
8805107Medicare ID - Type Unspecified
A48249Medicare UPIN
WA8806073Medicare PIN