MEDICARE: SOUTHERN PUJI MEDICAL CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1972445815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN PUJI MEDICAL CENTER PC

Provider Business Mailing Address
First Line	:	13847 E 14TH ST STE 113
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2625
Country	:	US
Telephone Number	:	510-618-1663
Fax Number	:

Provider Business Practice Location Address
First Line	:	13847 E 14TH ST STE 113
Second Line	:
City	:	SAN LEANDRO
State	:	CA
Zip	:	94578-2625
Country	:	US
Telephone Number	:	510-618-1663
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHAO HO
Credential	:	MD
Telephone Number	:	510-618-1663

Provider Enumeration Date	:	04/08/2026
Last Update Date	:	04/08/2026

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