MEDICARE: CLAYTON VALLEY MEDICAL GROUP, 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	G63252	CA

General Provider Information

NPI Number	:	1972656718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAYTON VALLEY MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	5439 CLAYTON RD STE B
Second Line	:
City	:	CLAYTON
State	:	CA
Zip	:	94517-1076
Country	:	US
Telephone Number	:	925-672-6744
Fax Number	:	925-672-3259

Provider Business Practice Location Address
First Line	:	5439 CLAYTON RD STE B
Second Line	:
City	:	CLAYTON
State	:	CA
Zip	:	94517-1076
Country	:	US
Telephone Number	:	925-672-6744
Fax Number	:	925-672-3259

Authorized Official
Title or Position	:	DOCTOR
Name	:	DR. STEVEN M KAPLAN
Credential	:	M.D.
Telephone Number	:	925-672-6744

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	03/28/2018

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