Jody Lynn Ullom, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G77729 Issued in CA

Practice address

1004 Northgate Dr
San Rafael, CA 94903-2502

Phone

(415) 590-6150

Fax

(415) 578-3118

NPI assigned

Mar 22, 2006

Last updated

May 18, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Golden Gate Pediatrics, a Medical Corporation

  • Pediatrics Physician
  • San Francisco, CA
  • NPI 1710043039
  NPD (past)
• University of California, San Francisco

  dba UCSF Medical Center

  • General Acute Care Hospital
  • San Francisco, CA
  • NPI 1689772592
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463529600000",
    "number": "1417916990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1004 NORTHGATE DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032502",
            "telephone_number": "415-590-6150",
            "fax_number": "415-578-3118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1004 NORTHGATE DR",
            "city": "SAN RAFAEL",
            "state": "CA",
            "postal_code": "949032502",
            "telephone_number": "415-590-6150",
            "fax_number": "415-578-3118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ULLOM",
        "first_name": "JODY",
        "middle_name": "LYNN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-22",
        "last_updated": "2016-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G77729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lydia Tuveson, PT
• Aria Twilling
• Thomas Joseph Uelk, DDS
• Tanya Uhl, CRNA
• Fernando Ulloa, M.D.
• Susan Mary Ann Ultsch, M.S.,CCC-SLP
• Madeline Underwood, MD
• Haluk E Uner, RPH,MS
• Lynda Beth Unkeless
• Amy Nicole Urban

• Pediatrics Physician in San Rafael, CA
• Providers in San Rafael, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.

Verify at the official NPI Registry.