Provider Demographics
NPI:1922517846
Name:JADE HEALTH CARE MEDICAL GROUP, INC
Entity Type:Organization
Organization Name:JADE HEALTH CARE MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:628-228-2707
Mailing Address - Street 1:445 GRANT AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:445 GRANT AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108
Practice Address - Country:US
Practice Address - Phone:415-677-2408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
No305R00000XManaged Care OrganizationsPreferred Provider Organization