Provider Demographics
NPI:1932320926
Name:HENRY GO MD INC
Entity Type:Organization
Organization Name:HENRY GO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-775-1711
Mailing Address - Street 1:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:COURTLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95615-0338
Mailing Address - Country:US
Mailing Address - Phone:916-775-1711
Mailing Address - Fax:916-775-2307
Practice Address - Street 1:11733 HIGHWAY 160
Practice Address - Street 2:
Practice Address - City:COURTLAND
Practice Address - State:CA
Practice Address - Zip Code:95615-0338
Practice Address - Country:US
Practice Address - Phone:916-775-1711
Practice Address - Fax:916-775-2307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A191200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A191200Medicaid
00A191200Medicare ID - Type Unspecified
CA00A191200Medicaid