Provider Demographics
NPI:1508974031
Name:SACRAMENTO FAMILY MEDICAL CLINIC
Entity Type:Organization
Organization Name:SACRAMENTO FAMILY MEDICAL CLINIC
Other - Org Name:HMONG NEW LIFE HEALTH CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-563-7230
Mailing Address - Street 1:3441 MARYSVILLE BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-4512
Mailing Address - Country:US
Mailing Address - Phone:916-563-7230
Mailing Address - Fax:916-563-7229
Practice Address - Street 1:4241 FLORIN RD
Practice Address - Street 2:SUITE 30
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2535
Practice Address - Country:US
Practice Address - Phone:916-427-1227
Practice Address - Fax:916-427-6325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA132640207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0053757Medicaid