Provider Demographics
NPI:1578833059
Name:JSMD PC
Entity Type:Organization
Organization Name:JSMD PC
Other - Org Name:JUMPSTARTMD, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-FOUNDER AND MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-241-6508
Mailing Address - Street 1:PO BOX 117627
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94011-7627
Mailing Address - Country:US
Mailing Address - Phone:650-241-6508
Mailing Address - Fax:925-482-1195
Practice Address - Street 1:350 LORTON AVENUE
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4104
Practice Address - Country:US
Practice Address - Phone:650-241-6508
Practice Address - Fax:925-482-1195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-30
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66219207QB0002X
207QB0002X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty