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NPI Code Detail

MEDICARE: TRI-VALLEY MEDICAL ASSOCIATES, INC.

MEDICARE: TRI-VALLEY MEDICAL ASSOCIATES, 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
1207Q00000XFamily Medicine Physician
2207QS1201XSleep Medicine (Family Medicine) Physician
3207RC0200XCritical Care Medicine (Internal Medicine) Physician
4207RP1001XPulmonary Disease Physician
5207R00000XInternal Medicine Physician

General Provider Information

NPI Number : 1801047931
Entity Type Code : Organization
Provider Name (Legal Business Name) : TRI-VALLEY MEDICAL ASSOCIATES, INC.
Provider Business Mailing Address
First Line : 87 FENTON ST STE 210
Second Line :
City : LIVERMORE
State : CA
Zip : 94550-4159
Country : US
Telephone Number : 925-371-8885
Fax Number : 925-371-8884
Provider Business Practice Location Address
First Line : 87 FENTON ST STE 210
Second Line :
City : LIVERMORE
State : CA
Zip : 94550-4159
Country : US
Telephone Number : 925-371-8885
Fax Number : 925-371-8884
Authorized Official
Title or Position : PRESIDENT
Name : DR. TSUNG PETER WONG
Credential : MD
Telephone Number : 925-371-8885
Provider Enumeration Date : 10/07/2008
Last Update Date : 10/12/2021

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1851800056 — MRS. DELISA SIMON RN, BSN, MSN, NP-C
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1790526424 — ALEXANDER NATHAN BONGERS DPT
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