Provider Demographics
NPI:1568999134
Name:PRIME ESSENTIAL HEALTH INC
Entity Type:Organization
Organization Name:PRIME ESSENTIAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF CORPORATION
Authorized Official - Prefix:
Authorized Official - First Name:EHSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SULTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-667-8520
Mailing Address - Street 1:9381 E STOCKTON BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-5070
Mailing Address - Country:US
Mailing Address - Phone:916-667-8520
Mailing Address - Fax:916-667-8635
Practice Address - Street 1:9381 E STOCKTON BLVD STE 220
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5070
Practice Address - Country:US
Practice Address - Phone:916-667-8520
Practice Address - Fax:916-667-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA49614207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699853317OtherFAMILY MEDICINE