=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831122696
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMUNITY HOSPITALIST MEDICAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2823 FRESNO ST
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93721-1324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-228-5478
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3436 N FORESTIERE AVE
-----------------------------------------------------
City | FRESNO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93722-7114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 408-394-3655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HOSPITALIST
-----------------------------------------------------
Name | DR. BAO ANH NGUYEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 559-228-5478
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A89126
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------