Provider Demographics
NPI:1396221693
Name:WELLCARE PHYSICIANS GROUP
Entity Type:Organization
Organization Name:WELLCARE PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUAMING
Authorized Official - Middle Name:
Authorized Official - Last Name:CHOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-334-7264
Mailing Address - Street 1:1325 HOWARD AVE # 828
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3356 EAST AVE
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4744
Practice Address - Country:US
Practice Address - Phone:530-451-6609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty