Provider Demographics
NPI:1285625509
Name:PLEASANTON EMERGENCY MEDICAL GROUP
Entity type:Organization
Organization Name:PLEASANTON EMERGENCY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-519-2089
Mailing Address - Street 1:PO BOX 920133
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75392-0143
Mailing Address - Country:US
Mailing Address - Phone:888-254-6697
Mailing Address - Fax:626-623-1227
Practice Address - Street 1:5555 W LAS POSITAS BLVD
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:209-342-2300
Practice Address - Fax:209-524-4240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA040027207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ08094ZOtherBLUE SHIELD
CAGR0094321Medicaid
CAZZZ08094ZOtherBLUE SHIELD