# GOLDEN STATE PHYSICIANS MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245386218
- **Authorized official:** DR. GORDON WONG M.D. (PRESIDENT OF THE BOARD)
- **Authorized official phone:** (530) 271-3200

## Contact information

- **Practice address:** 900 E MAIN ST STE 301, GRASS VALLEY, CA 95945-5853
- **Practice address phone:** (530) 271-3200
- **Practice address fax:** (530) 274-6347
- **Mailing address:** 900 E MAIN ST STE 301, GRASS VALLEY, CA 95945-5853
- **Mailing address phone:** (530) 271-3200
- **Mailing address fax:** (530) 274-6347

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 01/25/2007
- **Last updated:** 08/22/2020