=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912588914
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMARTCARE MEDICAL GROUP, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2021
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 255 W HERNDON AVE STE 103
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93612-0381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-570-0070
-----------------------------------------------------
Fax | 559-570-0059
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 255 W HERNDON AVE STE 103
-----------------------------------------------------
City | CLOVIS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93612-0381
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 559-570-0070
-----------------------------------------------------
Fax | 559-570-0059
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE ADMINISTRATOR
-----------------------------------------------------
Name | MR. IVAN LUK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 559-570-0070
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------