| Pacific Wound Center Medical Group, Inc. | |
|
4722 Quail Lakes Dr Suite A Stockton CA 95207-5256 | |
| (209) 476-0675 | |
| (209) 476-9389 |
| Full Name | Pacific Wound Center Medical Group, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 4722 Quail Lakes Dr, Stockton, California |
| Authorized Official Name and Position | William D. Mcdonald (OWNER/AUTHORIZED OFFICIAL,(PER PECO) |
| Authorized Official Contact | 2094760675 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Wound Center Medical Group, Inc. 4722 Quail Lakes Dr Suite A Stockton CA 95207-5256 Ph: (209) 476-0675 | Pacific Wound Center Medical Group, Inc. 4722 Quail Lakes Dr Suite A Stockton CA 95207-5256 Ph: (209) 476-0675 |
| NPI Number | 1659399202 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 11/23/2015 |
| Medicare PECOS PAC ID | 2163419581 |
|---|---|
| Medicare Enrollment ID | O20040428000524 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659399202 | NPI | - | NPPES |
| ZZZ07794Z | Other | CA | BLUE SHIELD |
| ZZZ07794Z | Other | BLUE SHIELD |
| Provider Name | Annette Maria Seiler |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629008339 PECOS PAC ID: 9133109291 Enrollment ID: I20040721000439 |
| Provider Name | Kenneth Ken Shimozaki |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1053429027 PECOS PAC ID: 7416056205 Enrollment ID: I20070619000684 |
| Provider Name | Surrender Raina |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1184662165 PECOS PAC ID: 1759322589 Enrollment ID: I20080606000348 |
| Provider Name | Parminder P Jagur |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1083053342 PECOS PAC ID: 1153634357 Enrollment ID: I20150716002842 |
| Provider Name | Xingbo P Sun |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1841639200 PECOS PAC ID: 9931491487 Enrollment ID: I20160701001759 |
| Provider Name | Seiha Thorng |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1104100221 PECOS PAC ID: 1052532785 Enrollment ID: I20161220002429 |
| Provider Name | Jonathan M Deguzman |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1962820597 PECOS PAC ID: 4688941222 Enrollment ID: I20170601002012 |
| Provider Name | Joshua B Stauffer |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1356710974 PECOS PAC ID: 9133468663 Enrollment ID: I20191125001773 |
| Provider Name | Daniel K Kim |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1427581016 PECOS PAC ID: 0941578447 Enrollment ID: I20200921000922 |
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San Joaquin County Clinics Chs Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1414 N California St Suite A, Stockton, CA 95202 Phone: 209-953-6400 Fax: 209-468-2321 | |
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