Provider Demographics
NPI:1104970953
Name:METRO MEDICAL ASSOCIATES, INC.
Entity type:Organization
Organization Name:METRO MEDICAL ASSOCIATES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:YU
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-295-4159
Mailing Address - Street 1:745 S STATE HIGHWAY 65
Mailing Address - Street 2:STE 20 PMB 216
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-9334
Mailing Address - Country:US
Mailing Address - Phone:916-295-4159
Mailing Address - Fax:
Practice Address - Street 1:745 S STATE HIGHWAY 65
Practice Address - Street 2:STE 20 PMB 216
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-9334
Practice Address - Country:US
Practice Address - Phone:916-295-4159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78963261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23934ZMedicare ID - Type Unspecified
CAG22482Medicare UPIN