1104972082 NPI number — USW MEDICAL GROUP CORPORATION

Table of content: (NPI 1104972082)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104972082 NPI number — USW MEDICAL GROUP CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USW MEDICAL GROUP CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SEN LIN WANG MEDICAL CENTER
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1104972082
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10516 LOWER AZUSA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL MONTE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91731-1684
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-444-5858
Provider Business Mailing Address Fax Number:
626-443-5858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10516 LOWER AZUSA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL MONTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91731-1684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-444-5858
Provider Business Practice Location Address Fax Number:
626-443-5858
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DU
Authorized Official First Name:
WENDY
Authorized Official Middle Name:
WEI
Authorized Official Title or Position:
MEDICAL BILLER
Authorized Official Telephone Number:
626-319-5881

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC6918 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AC6918 . This is a "1" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AC0069180 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com