California Emergency Physicians Medical Group, a Professional Corp
Organization Active NPI Emergency Medicine Physician · Moss Beach, CA
NPI 1306263231 · NPPES record last updated Mar 28, 2014
Key facts
- NPI
- 1306263231
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- CALIFORNIA EMERGENCY PHYSICIANS MEDICAL GROUP, A PROFESSIONAL CORP
- Practice address
- 600 Marine Blvd
Moss Beach, CA 94038-9641 - Phone
- (650) 563-7100
- NPI assigned
- Mar 28, 2014
- Organization subpart
- No
Authorized official
- Name
- Theophile Koury, MD
- Title
- President
- Phone
- (510) 350-2600
Other NPIs on the same Medicare enrollment 44
Practitioners 3
-
Michael Robert McCarthy, M.D./PH.D.
-
Kyaw Khine Soe, M.D.
-
Sunye Kwack Vuong, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140227000392 | CA | Part B Supplier - Clinic/Group Practice | 3274763875 |
Receives reassigned benefits from 141 practitioners 44 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Glendale, CA; Yuba City, CA; Truckee, CA; Sonora, CA; Millbrae, CA; Los Gatos, CA; Laguna Hills, CA; Fountain Valley, CA… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes |
Addresses
Primary practice location
600 Marine Blvd
Moss Beach, CA 94038-9641
Mailing address
2100 Powell St
Suite 900
Emeryville, CA 94608-1826
Phone (510) 350-2600
Other providers in Moss Beach, CA
- Lisa M Brown
- Jeaniesar Brawner Caluag
- Monica Candelore
- Cep America - California
- Cielo House Inc
- Cielomar Recovery, Inc.
All providers in Moss Beach, CA · Emergency Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 28, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.