=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922195189
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NATOMAS FAMILY PRACTICE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2006
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2410 DEL PASO RD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95834-9607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-928-0856
-----------------------------------------------------
Fax | 916-928-1754
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2410 DEL PASO RD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95834-9607
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-928-0856
-----------------------------------------------------
Fax | 916-928-1754
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | STEVE HWANG
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 916-928-0856
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20A80820
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------