MODESTO KIDNEY MEDICAL GROUP NPI 1306848569

NPI Information

NPI: 1306848569
Provider Name: MODESTO KIDNEY MEDICAL GROUP

Former Legal Business Name: ITSARA AND LIU MD'S

Classification: Internal Medicine - 207RN0300X
Entity Type: Organization

Specialization: Nephrology

Address:
305 E GRANGER AVE
STE 202
MODESTO, CA
ZIP 95350
Phone: (209) 526-1606
Get Directions

MODESTO KIDNEY MEDICAL GROUP is a nephrology internal medicine in Modesto, CA. The provider is an internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. MODESTO KIDNEY MEDICAL GROUP NPI is 1306848569. The provider is registered as an organization entity type and is a single specialty group.
The provider Former Legal Business Name Is Itsara And Liu Md's.

The provider's business location address is:

305 E GRANGER AVE
STE 202
MODESTO, CA
ZIP 95350-344
Phone: (209) 526-1606
Fax: (209) 526-1677

The provider's authorized official is Lori D Meischke .
The authorized official title is Billing Manager and has the following contact phone number (541) 706-9073.

The CLIA number assigned to this NPI record is 05D0610308 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 6/1/2005 and was last updated on 3/29/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207RN0300X	Internal Medicine	Nephrology	01031187 02	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	YYY49963Y	MEDICARE PIN	CALIFORNIA
2	GR0026660	MEDICAID	CALIFORNIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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