| Asante Medical Group | |
|
1551 Bishop St Suite 310 San Luis Obispo CA 93401-4635 | |
| (805) 242-4455 | |
| (805) 547-1395 |
| Full Name | Asante Medical Group |
|---|---|
| Speciality | Internal Medicine |
| Location | 1551 Bishop St, San Luis Obispo, California |
| Authorized Official Name and Position | Karen Ann Fong (OWNER) |
| Authorized Official Contact | 8052424455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Asante Medical Group 1241 Johnson Ave #322 San Luis Obispo CA 93401-3306 Ph: (805) 242-4455 | Asante Medical Group 1551 Bishop St Suite 310 San Luis Obispo CA 93401-4635 Ph: (805) 242-4455 |
| NPI Number | 1629321849 |
|---|---|
| Provider Enumeration Date | 10/25/2012 |
| Last Update Date | 03/06/2013 |
| Medicare PECOS PAC ID | 9931351715 |
|---|---|
| Medicare Enrollment ID | O20121129000481 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629321849 | NPI | - | NPPES |
| G70251 | Other | CA | CA MD LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | G70251 (California) | Primary |
| 208000000X | Pediatrics | G70251 (California) | Secondary |
| Provider Name | Karen A Fong |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1851396816 PECOS PAC ID: 5698731016 Enrollment ID: I20100304000119 |
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