Provider Demographics
NPI:1912588914
Name:SMARTCARE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:SMARTCARE MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-570-0070
Mailing Address - Street 1:255 W HERNDON AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-0381
Mailing Address - Country:US
Mailing Address - Phone:559-570-0070
Mailing Address - Fax:559-570-0059
Practice Address - Street 1:255 W HERNDON AVE STE 103
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-0381
Practice Address - Country:US
Practice Address - Phone:559-570-0070
Practice Address - Fax:559-570-0059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SMARTCARE MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-20
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4691222OtherARTICLES OF CORPORATION