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General NPI Number Information
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NPI Number | 1396221693
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Entity Type | Organization
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Legal Business Name | WELLCARE PHYSICIANS GROUP
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 07/19/2018
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Provider Practice Location Address
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Address Line | 3356 EAST AVE
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City | LIVERMORE
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State | CA
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Zip | 94550-4744
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Country | US
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Telephone | 530-451-6609
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 HOWARD AVE # 828
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City | BURLINGAME
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State | CA
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Zip | 94010-4212
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. HUAMING CHOU
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Credential | MD
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Telephone | 707-334-7264
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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