Basic Information
| Provider Information | |||||||||
| NPI: | 1285229724 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | HAYDEN | ||||||||
| MiddleName: | KIP | ||||||||
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| Credential: | RN. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 9TH ST APT 417 | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941031446 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2070 CLINTON AVE | ||||||||
| Address2: | |||||||||
| City: | ALAMEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945014399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105234357 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2021 | ||||||||
| LastUpdateDate: | 03/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 95186068 | CA | Y | Nursing Service Providers | Registered Nurse | Critical Care Medicine |
No ID Information.