Dignity Health Medical Foundation

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

DIGNITY HEALTH MEDICAL FOUNDATION

Doing business as

Dignity Health Medical Group - Stockton, a service of Dignity Health M

Practice address

534 E Pine St
Suite B
Stockton, CA 95204-5536

Phone

(209) 466-1980

Fax

(209) 466-1982

NPI assigned

Nov 5, 2008

Last updated

Nov 18, 2020By the provider in NPPES

Organization subpart

Yes

Parent organization

DIGNITY HEALTH MEDICAL FOUNDATIONAs reported in NPPES

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

Authorized official

Name

Theresa M Hylen

Title

Chief Financial Officer

Phone

(916) 851-2559

Specialties & licenses 1

Addresses

Other names 1

• Dignity Health Medical Group - Stockton, a service of Dignity Health M Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Part of

Woodland Clinic Med GRP

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.

• Maynard F. Lang, M.D.

  • General Practice Physician
  • Stockton, CA
  • NPI 1396720355
  NPD (past)

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605657600000",
    "number": "1609020569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 Q ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "95816",
            "telephone_number": "916-733-5701",
            "fax_number": "916-859-1671"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "534 E PINE ST",
            "address_2": "SUITE B",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952045536",
            "telephone_number": "209-466-1980",
            "fax_number": "209-466-1982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGNITY HEALTH MEDICAL FOUNDATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DIGNITY HEALTH MEDICAL FOUNDATION",
        "enumeration_date": "2008-11-05",
        "last_updated": "2020-11-18",
        "certification_date": "2020-11-18",
        "status": "A",
        "authorized_official_last_name": "HYLEN",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "916-851-2559"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dignity Health Medical Group - Stockton, a service of Dignity Health M",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dignity Health Medical Group - Stockton, a service of Dignity Health M",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kaylee Dieu
• Gabrielle Difiore, DO
• Prasad Dighe, MD
• Dignity Health (HealthCare Clinical Laboratories)
• Dignity Health Medical Foundation (Dignity Health Medical Group - Stockton, a service of Dignity Health M)
• Dignity Health Medical Foundation (Dignity Health Medical Group - Stockton, a service of Dignity Health M)
• Dignity Health Medical Foundation (Dignity Health Medical Group - Stockton, a service of Dignity Health M)
• Katrina Lugtu Dijamco, CPNP
• Jenna Dilig
• Kelsey Dillard

• Multi-Specialty Clinic/Center in Stockton, CA
• Providers in Stockton, CA by specialty
• Multi-Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.