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CALIFORNIA KIDNEY MEDICAL GROUP INC NPI 1760586705


NPI Information

NPI: 1760586705
Provider Name: CALIFORNIA KIDNEY MEDICAL GROUP, INC
Classification: Internal Medicine - 207RN0300X
Entity Type: Organization

Specialization: Nephrology

CLIA Number: 05D2260671

Address:
13990 BEAR FENCE CT
MOORPARK, CA
ZIP 93021
Phone: (818) 718-2301
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CALIFORNIA KIDNEY MEDICAL GROUP, INC is a nephrology internal medicine in Moorpark, 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. CALIFORNIA KIDNEY MEDICAL GROUP, INC NPI is 1760586705. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

13990 BEAR FENCE CT
MOORPARK, CA
ZIP 93021-022
Phone: (818) 718-2301
Fax: (818) 718-2311

The provider's authorized official is Joyce Van Bruck .
The authorized official title is Administrator and has the following contact phone number (818) 400-6396.

The CLIA number assigned to this NPI record is 05D2260671 - other - government employment with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/11/2006 and was last updated on 11/30/2016.


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
1207RN0300XInternal MedicineNephrologyYes

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
1GR0087560MEDICAIDCALIFORNIA
2W14882MEDICARE PINCALIFORNIA
3W14882BMEDICARE PINCALIFORNIA

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: 5/5/2024

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