=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861212664
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EUREKA HEALTH MEDICAL GROUP OF CALIFORNIA, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2024
-----------------------------------------------------
Last Update Date | 05/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5674 POGLIA CT
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95138-2234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-449-0494
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5674 POGLIA CT
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95138-2234
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ADMINISTRATIVE OFFICER
-----------------------------------------------------
Name | MRS. SINA HARTUNG
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 513-449-0494
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------