# ULTIMATE MALE

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

## Provider details

- **NPI number:** 1720878382
- **Authorized official:** YUAN WANG (MANAGER)
- **Authorized official phone:** (626) 319-5261

## Contact information

- **Practice address:** 360 E LAS TUNAS DR STE 204, SAN GABRIEL, CA 91776-5514
- **Practice address phone:** (626) 319-5261
- **Mailing address:** 360 E LAS TUNAS DR STE 204, SAN GABRIEL, CA 91776-5514

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 261QR0400X | Rehabilitation Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 05/07/2025
- **Last updated:** 05/08/2025