MEDICARE: SAINT JOSEPH FAMILY MEDICAL CLINIC, INC

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	207Q00000X	Family Medicine Physician	G72358	CA

General Provider Information

NPI Number	:	1023243193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAINT JOSEPH FAMILY MEDICAL CLINIC, INC

Provider Business Mailing Address
First Line	:	PO BOX 93723
Second Line	:
City	:	CITY OF INDUSTRY
State	:	CA
Zip	:	91715-3723
Country	:	US
Telephone Number	:	323-277-9010
Fax Number	:	323-277-9012

Provider Business Practice Location Address
First Line	:	2643 SANTA ANA ST
Second Line	:
City	:	SOUTH GATE
State	:	CA
Zip	:	90280-2025
Country	:	US
Telephone Number	:	323-277-9010
Fax Number	:	323-277-9012

Authorized Official
Title or Position	:	CEO
Name	:	DR. PETER E WU
Credential	:	M.D.
Telephone Number	:	323-277-9010

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	06/04/2014

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