| NPI | 1437377421 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN FONG Associate Director 415-457-3755 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2800X Clinic/Center, Methadone Clinic (Licence: CA 21-70) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: CA 110000417) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2017-08-24 |