MEDICARE: DR. SPIEN GHAR KOMAK BS, MD

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	A183531	CA
2	261QU0200X	Urgent Care Clinic/Center	A183531	CA

General Provider Information

NPI Number	:	1275097131
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SPIEN GHAR KOMAK BS, MD

Provider Business Mailing Address
First Line	:	1201 ALHAMBRA BLVD STE 230
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-5241
Country	:	US
Telephone Number	:	916-731-7728
Fax Number	:	916-731-7815

Provider Business Practice Location Address
First Line	:	8170 LAGUNA BLVD STE 113
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7902
Country	:	US
Telephone Number	:	916-478-6561
Fax Number	:	916-478-6573

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/24/2019
Last Update Date	:	06/21/2026

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