Provider Demographics
NPI:1679657365
Name:KAUFMANN, SALLY HAVNER (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:HAVNER
Last Name:KAUFMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 AVILA STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-1106
Mailing Address - Country:US
Mailing Address - Phone:415-567-3535
Mailing Address - Fax:415-567-1075
Practice Address - Street 1:324 AVILA STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-1106
Practice Address - Country:US
Practice Address - Phone:415-567-3535
Practice Address - Fax:415-567-1075
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG64252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA024129Medicaid
OOOC64251Medicare ID - Type Unspecified
CA024129Medicaid