Provider Demographics
NPI:1497919112
Name:PREMIER CARE IPA
Entity Type:Organization
Organization Name:PREMIER CARE IPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL MEDICINE & REHAB
Authorized Official - Prefix:DR
Authorized Official - First Name:TUYEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-258-3229
Mailing Address - Street 1:1865 ALUM ROCK AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116-1396
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1865 ALUM ROCK AVE STE A
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1396
Practice Address - Country:US
Practice Address - Phone:408-258-3229
Practice Address - Fax:408-258-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization