Provider Demographics
NPI:1104923879
Name:BRANDENHOFF, PREBEN (MD)
Entity type:Individual
Prefix:DR
First Name:PREBEN
Middle Name:
Last Name:BRANDENHOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 CLAY ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3479
Mailing Address - Country:US
Mailing Address - Phone:415-823-1954
Mailing Address - Fax:415-359-1954
Practice Address - Street 1:1950 CLAY ST
Practice Address - Street 2:401
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-3479
Practice Address - Country:US
Practice Address - Phone:415-823-1954
Practice Address - Fax:415-359-1954
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81697208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH56210Medicare UPIN