Basic Information
| Provider Information | |||||||||
| NPI: | 1730474933 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LONDON | ||||||||
| FirstName: | BRETT | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 SUTTER ST FL 2 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941044009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156586791 | ||||||||
| FaxNumber: | 4155200904 | ||||||||
| Practice Location | |||||||||
| Address1: | 1801 SHATTUCK AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947091871 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102251025 | ||||||||
| FaxNumber: | 5102251019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2011 | ||||||||
| LastUpdateDate: | 07/10/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | TL-4021 | CO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 13489 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.