Provider Demographics
NPI:1285637942
Name:SACRAMENTO COLON & RECTAL SURGERY MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SACRAMENTO COLON & RECTAL SURGERY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-231-1050
Mailing Address - Street 1:1020 29TH ST
Mailing Address - Street 2:STE 350
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5173
Mailing Address - Country:US
Mailing Address - Phone:916-231-1050
Mailing Address - Fax:916-231-1055
Practice Address - Street 1:1020 29TH ST
Practice Address - Street 2:STE 350
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5173
Practice Address - Country:US
Practice Address - Phone:916-231-1050
Practice Address - Fax:916-231-1055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG52872174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC46651Medicare UPIN
CAZZZ26720ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER #
CAH59319Medicare UPIN
CAE39096Medicare UPIN