MEDICARE: CAREMORE HEALTH PLAN

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	363LF0000X	Family Nurse Practitioner	A97680	CA

General Provider Information

NPI Number	:	1568834505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAREMORE HEALTH PLAN

Provider Business Mailing Address
First Line	:	4855 ATHERTON AVE STE 101
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4855 ATHERTON AVE STE 101
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1026
Country	:	US
Telephone Number	:	408-963-2400
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	JOHNNY CHOI
Credential	:
Telephone Number	:	408-963-2400

Provider Enumeration Date	:	10/29/2015
Last Update Date	:	10/29/2015

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