=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790598340
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ONE ALPHACARE MEDICAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2025
-----------------------------------------------------
Last Update Date | 01/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 SNEATH LN STE 208
-----------------------------------------------------
City | SAN BRUNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94066-2404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-530-3210
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 SNEATH LN STE 208
-----------------------------------------------------
City | SAN BRUNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94066-2404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INCORPORATOR
-----------------------------------------------------
Name | KWOK FUNG WONG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 415-867-9780
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0005X
-----------------------------------------------------
Taxonomy Name | Ambulatory Family Planning Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------