1730691296 NPI number — ACCESS PRIMARY CARE MEDICAL GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730691296 NPI number — ACCESS PRIMARY CARE MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACCESS PRIMARY CARE MEDICAL GROUP
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:
Provider Other Organization Name Type Code:
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:
1730691296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1580 VALENCIA ST STE 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN FRANCISCO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94110-4415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-303-0220
Provider Business Mailing Address Fax Number:
650-991-1800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1580 VALENCIA ST STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN FRANCISCO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94110-4415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-303-0220
Provider Business Practice Location Address Fax Number:
650-991-1800
Provider Enumeration Date:
10/24/2017

Additional Information

Authorized Official

Authorized Official Last Name:
CHAO
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
415-333-3302

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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