Provider Demographics
NPI:1942200746
Name:STANLEY Y. LOUIE DO, INC
Entity Type:Organization
Organization Name:STANLEY Y. LOUIE DO, INC
Other - Org Name:LOGAN STREET MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDEN/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STANLEY
Authorized Official - Middle Name:YOUNG
Authorized Official - Last Name:LOUIE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:559-896-2624
Mailing Address - Street 1:2511 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-3012
Mailing Address - Country:US
Mailing Address - Phone:559-896-2624
Mailing Address - Fax:559-896-3235
Practice Address - Street 1:2511 LOGAN ST
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3012
Practice Address - Country:US
Practice Address - Phone:559-896-2624
Practice Address - Fax:559-896-3235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A65700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0081530Medicaid
CAZZZ53815ZOtherBLUE SHIELD
CA020A65700OtherBLUE CROSS
CAZZZ53815ZOtherBLUE SHIELD