Provider Demographics
NPI:1023243193
Name:SAINT JOSEPH FAMILY MEDICAL CLINIC, INC
Entity type:Organization
Organization Name:SAINT JOSEPH FAMILY MEDICAL CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:E
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-277-9010
Mailing Address - Street 1:PO BOX 93723
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91715-3723
Mailing Address - Country:US
Mailing Address - Phone:323-277-9010
Mailing Address - Fax:323-277-9012
Practice Address - Street 1:2643 SANTA ANA ST
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2025
Practice Address - Country:US
Practice Address - Phone:323-277-9010
Practice Address - Fax:323-277-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-19
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72358207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty