Provider Demographics
NPI:1629170998
Name:GASTROENTEROLOGY SPECIALISTS MEDICAL GROUP, INC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SPECIALISTS MEDICAL GROUP, INC A MEDICAL CORPORATION
Other - Org Name:GASTROENTEROLOGY SPECIALISTS MEDICAL GROUP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WEI-FANG KO
Authorized Official - Middle Name:
Authorized Official - Last Name:KO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-537-4415
Mailing Address - Street 1:19845 LAKE CHABOT RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-4055
Mailing Address - Country:US
Mailing Address - Phone:510-537-4415
Mailing Address - Fax:
Practice Address - Street 1:19845 LAKE CHABOT RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-4055
Practice Address - Country:US
Practice Address - Phone:510-537-4415
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty