Healthcare Provider Details

I. General information

NPI: 1093361354
Provider Name (Legal Business Name): AFFINITY HEALTH ADVANTAGE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 09/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 S SHORE CTR # 250
ALAMEDA CA
94501-8073
US

IV. Provider business mailing address

302 CHERRY ST
ARITA IA
50020
US

V. Phone/Fax

Practice location:
  • Phone: 510-323-4410
  • Fax:
Mailing address:
  • Phone: 712-249-3661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: KINJAL PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 510-323-4410