Healthcare Provider Details

I. General information

NPI: 1285625509
Provider Name (Legal Business Name): PLEASANTON EMERGENCY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W LAS POSITAS BLVD
PLEASANTON CA
94588
US

IV. Provider business mailing address

PO BOX 920133
DALLAS TX
75392-0143
US

V. Phone/Fax

Practice location:
  • Phone: 209-342-2300
  • Fax: 209-524-4240
Mailing address:
  • Phone: 626-327-6795
  • Fax: 626-623-1227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number040027
License Number StateCA

VIII. Authorized Official

Name: EDWARD Y KAN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 925-519-2089