Provider Demographics
NPI:1619060159
Name:UPHOFF, KATHERINE J (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:J
Last Name:UPHOFF
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-6913
Mailing Address - Country:US
Mailing Address - Phone:650-589-6500
Mailing Address - Fax:661-678-4626
Practice Address - Street 1:192 BEACON ST.
Practice Address - Street 2:
Practice Address - City:SO. SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080
Practice Address - Country:US
Practice Address - Phone:650-589-6500
Practice Address - Fax:661-678-4626
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20734363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ29785Medicare UPIN
NYWEA041Medicare ID - Type UnspecifiedGROUP NUMBER