MEDICARE: PLEASANTON URGENT CARE MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1003768904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANTON URGENT CARE MEDICAL GROUP

Provider Business Mailing Address
First Line	:	4000 DUBLIN BLVD STE 150
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-3180
Country	:	US
Telephone Number	:	877-346-2211
Fax Number	:	407-324-4727

Provider Business Practice Location Address
First Line	:	4000 DUBLIN BLVD STE 150
Second Line	:
City	:	DUBLIN
State	:	CA
Zip	:	94568-3180
Country	:	US
Telephone Number	:	877-346-2211
Fax Number	:	407-324-4727

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	EDWARD KAN
Credential	:	MD
Telephone Number	:	877-346-2211

Provider Enumeration Date	:	02/12/2026
Last Update Date	:	02/12/2026

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