Provider Demographics
NPI:1790968717
Name:HARVEY, KRISTEN
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:
Last Name:HARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31636
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-0636
Mailing Address - Country:US
Mailing Address - Phone:917-975-9484
Mailing Address - Fax:
Practice Address - Street 1:1 DANIEL BURNHAM CT STE 370C
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-0470
Practice Address - Country:US
Practice Address - Phone:415-732-7029
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2023-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224698207Q00000X
CAC152720207Q00000X
CODR.0060879207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02532736Medicaid
NY02532736Medicaid