NPIMap

Organization Active NPI

Active Life Medical Center

  • Chiropractor
  • Redwood City, CA
National Provider Identifier
1639392798
Registry record updated Oct 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
14813 Issued in CA
Legal business name
ACTIVE LIFE MEDICAL CENTER
Practice address
1391 Woodside Rd
200
Redwood City, CA 94061-3578
Phone
(650) 365-7775
Fax
(365) 365-7896
NPI assigned
Apr 10, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2007

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

Authorized official

Name
Mr. Harry Kevin Wong, DCNPI 1841352416
Title
Medical Director
Phone
(650) 365-7775

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X 14813 CA Primary

Addresses

Primary practice location

1391 Woodside Rd
200
Redwood City, CA 94061-3578

Mailing address

1391 Woodside Rd
200
Redwood City, CA 94061-3578
Phone (650) 365-7775

Other identifiers 2

IdentifierTypeStateIssuer
14813OtherCALICENSE
A69755OtherCALICENSE

Other names 1

  • Physicians Plus Medical Group Former legal business name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191888000000",
    "number": "1639392798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1391 WOODSIDE RD",
            "address_2": "200",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940613578",
            "telephone_number": "650-365-7775",
            "fax_number": "365-365-7896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1391 WOODSIDE RD",
            "address_2": "200",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940613578",
            "telephone_number": "650-365-7775",
            "fax_number": "365-365-7896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE LIFE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2007-10-09",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "HARRY",
        "authorized_official_middle_name": "KEVIN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "650-365-7775",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "14813",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "14813",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "A69755",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Physicians Plus Medical Group",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Redwood City, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2007; 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.