Provider Demographics
NPI:1710996467
Name:HERBERT S. KAUFMAN, M.D., MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HERBERT S. KAUFMAN, M.D., MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-459-4601
Mailing Address - Street 1:1100 SIR FRANCIS DRAKE BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1419
Mailing Address - Country:US
Mailing Address - Phone:415-459-0600
Mailing Address - Fax:415-459-4607
Practice Address - Street 1:1100 SIR FRANCIS DRAKE BLVD STE 2
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1419
Practice Address - Country:US
Practice Address - Phone:415-459-0600
Practice Address - Fax:415-459-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC25773207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ30909ZMedicare ID - Type Unspecified
CAZZZ30908ZMedicare ID - Type Unspecified
CAA32964Medicare UPIN