MEDICARE: CHW MEDICAL FOUNDATION

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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1942430566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHW MEDICAL FOUNDATION

Provider Business Mailing Address
First Line	:	3000 Q ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-7058
Country	:	US
Telephone Number	:	916-733-5701
Fax Number	:	916-859-1671

Provider Business Practice Location Address
First Line	:	4987 GOLDEN FOOTHILL PKWY
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-9636
Country	:	US
Telephone Number	:	916-933-4222
Fax Number	:	916-933-5574

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	THERESA M HYLEN
Credential	:
Telephone Number	:	916-851-2559

Provider Enumeration Date	:	07/16/2009
Last Update Date	:	11/18/2020

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