Wall Medical Group

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

ZZZ96273Z Issued in CA

Legal business name

WALL MEDICAL GROUP

Practice address

455 Grand Ave
South San Francisco, CA 94080-3635

Phone

(650) 636-1286

Fax

(650) 588-4164

NPI assigned

May 11, 2006

Last updated

Oct 20, 2014By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Catherine Brooks

Title

Office Manager

Phone

(650) 636-1291

Specialties & licenses 7

Addresses

Other identifiers 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Daniel Lentz, MD

  • Diagnostic Radiology Physician
  • San Francisco, CA
  • NPI 1275571523
  NPD (past)

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

{
    "created_epoch": "1147305600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413763200000",
    "number": "1427008135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 UNION ST",
            "address_2": "SUITE 300",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941234114",
            "telephone_number": "650-636-1291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "455 GRAND AVE",
            "city": "SOUTH SAN FRANCISCO",
            "state": "CA",
            "postal_code": "940803635",
            "telephone_number": "650-636-1286",
            "fax_number": "650-588-4164"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALL MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-11",
        "last_updated": "2014-10-20",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "650-636-1291"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "ZZZ96273Z",
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL",
            "identifier": "GR0020880",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph A. Wagenhofer
• Walgreen Co (Walgreens #15397)
• Walgreen Co (Walgreens #03346)
• Walgreens
• Walgreens Pharmacy
• Wall Medical Inc (PMC Laboratory Services)
• Catherine Wall, PT
• Amy Wang
• Jung Wang, CCC-SLP
• Qingping Wang, M.D., PH.D.

• General Practice Physician in South San Francisco, CA
• Providers in South San Francisco, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2014; 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.