Provider Demographics
NPI:1649664566
Name:KERKHOFF, ANDREW DALE
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:DALE
Last Name:KERKHOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:RM. 987
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0119
Mailing Address - Country:US
Mailing Address - Phone:415-476-1528
Mailing Address - Fax:415-502-1976
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:RM. 987
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0119
Practice Address - Country:US
Practice Address - Phone:415-476-1528
Practice Address - Fax:415-502-1976
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-28
Last Update Date:2015-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program