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General NPI Number Information
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NPI Number | 1619233582
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Entity Type | Organization
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Legal Business Name | CAPITAL ADVANCED SURGERY A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/05/2012
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 8100 BRUCEVILLE RD
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City | SACRAMENTO
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State | CA
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Zip | 95823-2353
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Country | US
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Telephone | 916-714-6666
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Fax | 916-714-6677
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Provider Business Mailing Address
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Address Line | 3511 DEL PASO ROAD SUITE 160 PMB 226
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City | SACRAMENTO
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State | CA
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Zip | 95835-2808
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Country | US
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Telephone | 916-455-8666
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Fax | 916-455-8866
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WEN LONG
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Credential | M.D.
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Telephone | 916-455-8666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A113444
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License Number State | CA
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