Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | A173760 | CA |
N | 208600000X | Surgeon | A173760 | CA |
Y | 2086X0206X | Surgical Oncologist | A173760 | CA |
NPI | 1386094217 |
---|---|
Provider Name | Kimberly Ellis |
First Address | San Francisco, CA 94158-2545 |
Second Address | San Francisco, CA 94158-2545 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2016 |
Last Update Date | 22/07/2021 |