Provider Demographics
NPI:1962599118
Name:ELK GROVE FAMILY PHYSICIANS MEDICAL GROUP INC
Entity type:Organization
Organization Name:ELK GROVE FAMILY PHYSICIANS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-686-7373
Mailing Address - Street 1:9727 ELK GROVE FLORIN RD
Mailing Address - Street 2:STE. 140
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2264
Mailing Address - Country:US
Mailing Address - Phone:916-686-7373
Mailing Address - Fax:916-686-7374
Practice Address - Street 1:9727 ELK GROVE FLORIN RD
Practice Address - Street 2:STE. 140
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2264
Practice Address - Country:US
Practice Address - Phone:916-686-7373
Practice Address - Fax:916-686-7374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-09
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA068134207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTIN
CA=========OtherTIN