Provider Demographics
NPI:1669412029
Name:OSHITA, ALLEN KEN (MD)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:KEN
Last Name:OSHITA
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:P.O. BOX 6102
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-6102
Mailing Address - Country:US
Mailing Address - Phone:415-884-3418
Mailing Address - Fax:
Practice Address - Street 1:3700 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1618
Practice Address - Country:US
Practice Address - Phone:415-750-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG396982085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA300130318OtherRAILROAD MEDICARE
CA300130317OtherRAILROAD MEDICARE
CA00G396980Medicaid
CA300130317OtherRAILROAD MEDICARE
CA00G396983Medicare PIN
CA00G396980Medicare PIN
CA300130318OtherRAILROAD MEDICARE
CABX936YMedicare PIN
CA00G396984Medicare PIN