MEDICARE: OTASHE GOLDEN, MD, 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

General Provider Information

NPI Number	:	1912165598
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OTASHE GOLDEN, MD, INC.

Provider Business Mailing Address
First Line	:	9098 LAGUNA MAIN ST
Second Line	:	SUITE 6
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7449
Country	:	US
Telephone Number	:	916-691-6780
Fax Number	:	916-691-6799

Provider Business Practice Location Address
First Line	:	9098 LAGUNA MAIN ST
Second Line	:	SUITE 6
City	:	ELK GROVE
State	:	CA
Zip	:	95758-7449
Country	:	US
Telephone Number	:	916-691-6780
Fax Number	:	916-691-6799

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. OTASHE NYOKU GOLDEN
Credential	:	M.D.
Telephone Number	:	916-691-6780

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	03/18/2009

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