Provider Demographics
NPI:1891860193
Name:KASSELIK, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:KASSELIK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2100 WEBSTER STREET
Mailing Address - Street 2:STE 405
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:415-923-3456
Mailing Address - Fax:415-923-3121
Practice Address - Street 1:2100 WEBSTER STREET
Practice Address - Street 2:STE 405
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-923-3456
Practice Address - Fax:415-923-3121
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2013-07-18
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Provider Licenses
StateLicense IDTaxonomies
CAG62355207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G623551Medicaid
CA00G623554Medicare PIN
CAF14508Medicare UPIN