Provider Demographics
NPI:1225302540
Name:MOUNTAIN VIEW MEDICAL CARE, INC.
Entity Type:Organization
Organization Name:MOUNTAIN VIEW MEDICAL CARE, INC.
Other - Org Name:WEST AND EAST MEDICAL CARE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:SHAO
Authorized Official - Last Name:WITHERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-968-2389
Mailing Address - Street 1:4966 EL CAMINO REAL STE 111
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1406
Mailing Address - Country:US
Mailing Address - Phone:650-224-5497
Mailing Address - Fax:866-368-1227
Practice Address - Street 1:4966 EL CAMINO REAL STE 111
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1406
Practice Address - Country:US
Practice Address - Phone:650-224-5497
Practice Address - Fax:866-368-1227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72572261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH31721Medicare UPIN
CA00A725721Medicare PIN