Healthcare Provider Details

I. General information

NPI: 1275097131
Provider Name (Legal Business Name): SPIEN GHAR KOMAK BS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 06/21/2026
Certification Date: 06/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8170 LAGUNA BLVD STE 113
ELK GROVE CA
95758-7902
US

IV. Provider business mailing address

1201 ALHAMBRA BLVD STE 230
SACRAMENTO CA
95816-5241
US

V. Phone/Fax

Practice location:
  • Phone: 916-478-6561
  • Fax: 916-478-6573
Mailing address:
  • Phone: 916-731-7728
  • Fax: 916-731-7815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA183531
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA183531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: