Basic Information
| Provider Information | |||||||||
| NPI: | 1063456283 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GALEN INPATIENT PHYSICIANS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 POWELL ST STE 400 | ||||||||
| Address2: | |||||||||
| City: | EMERYVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946081826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103502644 | ||||||||
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| Practice Location | |||||||||
| Address1: | 225 N JACKSON AVE | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951161603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4083786131 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | KOURY | ||||||||
| AuthorizedOfficialFirstName: | THEOPHILE | ||||||||
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| AuthorizedOfficialTitleorPosition: | M.D | ||||||||
| AuthorizedOfficialTelephone: | 5103502644 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PRESIDENT | ||||||||
| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | GR0093523 | 05 | CA | MEDICAID |