Provider Demographics
NPI:1710183512
Name:COMMUNITY INTERNAL MEDICINE, INC.
Entity Type:Organization
Organization Name:COMMUNITY INTERNAL MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:WENDONG
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:408-846-1800
Mailing Address - Street 1:7880 WREN AVE.
Mailing Address - Street 2:SUITE # D-143
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7802
Mailing Address - Country:US
Mailing Address - Phone:408-846-1800
Mailing Address - Fax:408-846-1995
Practice Address - Street 1:7880 WREN AVE.
Practice Address - Street 2:SUITE # D-143
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7802
Practice Address - Country:US
Practice Address - Phone:408-846-1800
Practice Address - Fax:408-846-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA740740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A740740Medicaid
CA00A740740Medicaid
CA00A740740Medicare ID - Type Unspecified