Provider Demographics
NPI:1568783470
Name:PETERSEN, DANA KRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:KRISTOPHER
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3838 CALIFORNIA ST RM 505
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1507
Mailing Address - Country:US
Mailing Address - Phone:415-751-4914
Mailing Address - Fax:415-751-1414
Practice Address - Street 1:3838 CALIFORNIA ST RM 505
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1507
Practice Address - Country:US
Practice Address - Phone:415-751-4914
Practice Address - Fax:415-751-1414
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-15
Last Update Date:2021-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA128697207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck