Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G49959 | CA |
Y | 111NI0900X | Internist | G49959 | CA |
N | 207RA0401X | Internist - Addiction Medicine | G49959 | CA |
NPI | 1891889341 |
---|---|
Provider Name | Dr. John Edward Mendelson |
First Address | San Francisco, CA 94109-4822 |
Second Address | San Francisco, CA 94109-4822 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 05/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A51519 | (02) | CA |
G49959 | (05) | CA |