Provider Demographics
NPI:1962526038
Name:WELL CARE MEDICAL GROUP PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:WELL CARE MEDICAL GROUP PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONG
Authorized Official - Middle Name:
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-318-5585
Mailing Address - Street 1:311 E VALLEY BLVD STE 111-112
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91776-3554
Mailing Address - Country:US
Mailing Address - Phone:626-318-5585
Mailing Address - Fax:
Practice Address - Street 1:311 E VALLEY BLVD STE 111-112
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3554
Practice Address - Country:US
Practice Address - Phone:626-318-5585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty