Provider Demographics
NPI:1700653292
Name:KETETHA OLENGUE MD INCORPORATED
Entity Type:Organization
Organization Name:KETETHA OLENGUE MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KETETHA
Authorized Official - Middle Name:CLAUDE GERALDINE
Authorized Official - Last Name:OLENGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-567-6055
Mailing Address - Street 1:166 GEARY ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-5628
Mailing Address - Country:US
Mailing Address - Phone:650-567-6055
Mailing Address - Fax:
Practice Address - Street 1:2211 POST ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3442
Practice Address - Country:US
Practice Address - Phone:650-567-6055
Practice Address - Fax:859-955-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-05
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty