Active NPI
Boris Gutkovsky, CPT1
- Clinical Medical Laboratory
- San Francisco, CA
National Provider Identifier
1043679673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- License
- CPT9570
- Practice address
- 55 Chumasero Drive #2D
San Francisco, CA 94132-2319 - Phone
- (415) 585-5822
- NPI assigned
- Feb 10, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | CPT9570 | CA | Primary |
Addresses
Primary practice location
55 Chumasero Drive #2D
San Francisco, CA 94132-2319
Mailing address
55 Chumasero Dr Apt 2D
San Francisco, CA 94132-2319
Phone (415) 867-2235
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CPT9570 | CA | MD | Clinical Medical Laboratory |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1455062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1455062400000",
"number": "1043679673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 CHUMASERO DR APT 2D",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941322319",
"telephone_number": "415-867-2235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 CHUMASERO DRIVE #2D",
"city": "SAN FRANCISCO",
"state": "CA",
"postal_code": "941322319",
"telephone_number": "415-585-5822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTKOVSKY",
"first_name": "BORIS",
"credential": "CPT1",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-02-10",
"last_updated": "2016-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": "CA",
"license": "CPT9570",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Francisco, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.