GREEN PEACE MEDICAL GROUP NPI 1003801648

Family Medicine in San Gabriel, CA

Organization Family Medicine

About GREEN PEACE MEDICAL GROUP

Green Peace Medical Group is a provider established in San Gabriel, California specializing in family medicine. The NPI number of Green Peace Medical Group is 1003801648 and was assigned on September 2005. The practitioner's primary taxonomy code is 207Q00000X with license number A33409 (CA). The provider is registered as an organization and their NPI record was last updated 11 years ago. Green Peace Medical Group operates as a single speciality business group with one or more individual providers who practice the same area of specialization.
The authorized official of this NPI record is Sheng H Chang Md (Owner)

NPI

1003801648

Provider NameGREEN PEACE MEDICAL GROUP
Provider Location Address330 W LAS TUNAS DR SUITE 3 SAN GABRIEL, CA 91776
Provider Mailing Address330 W LAS TUNAS DR SUITE 3 SAN GABRIEL, CA 91776
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date09-20-2005
Last Update Date06-16-2008

Primary Taxonomy

Taxonomy Code207Q00000X
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License No.A33409
License StateCA
Taxonomy DescriptionFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Business Address

GREEN PEACE MEDICAL GROUP
330 W LAS TUNAS DR
SUITE 3
SAN GABRIEL, CA
ZIP 91776
Phone: (626) 573-0055
Fax: (626) 573-4087

Get Directions

Mailing Address

GREEN PEACE MEDICAL GROUP
330 W LAS TUNAS DR
SUITE 3
SAN GABRIEL, CA
ZIP 91776
Phone: (626) 573-0055
Fax: (626) 573-4087

Authorized Official

Authorized Official Name SHENG H CHANG MD
Authorized Official TitleOWNER
Authorized Official Phone(626) 573-0055

Group Taxonomy


193400000X SINGLE SPECIALTY GROUP - This provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
W16194MEDICARE ID-TYPE UNSPECIFIED (04)CA
GR0091430MEDICAID (05)CA

Other Providers at the same location


The following 4 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1215036215DR. ARDESHIR KARIMI MD
Individual
330 W LAS TUNAS DR SUITE C
SAN GABRIEL, CA 91776
(626) 282-9250
1679804728SHENG H. CHANG, M.D., INC.
Organization
Clinic/Center330 W LAS TUNAS DR SUITE 3
SAN GABRIEL, CA 91776
(626) 573-0055
1770851099FRANCISCO RODRIGUEZ, D.O.
Organization
Clinic/Center (Health Service)330 W LAS TUNAS DR SUITE#1
SAN GABRIEL, CA 91776
(626) 289-0040
1871589903 SHENG H CHANG MD
Individual
Family Medicine330 W LAS TUNAS DR SUITE 3
SAN GABRIEL, CA 91776
(626) 573-0055

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.

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