Healthcare Provider Details

I. General information

NPI: 1295258341
Provider Name (Legal Business Name): PACIFIC NEPHROLOGY ASSOCIATES MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1211 W LA PALMA AVE STE 102
ANAHEIM CA
92801-2809
US

IV. Provider business mailing address

3080 BRISTOL ST STE 600
COSTA MESA CA
92626-7341
US

V. Phone/Fax

Practice location:
  • Phone: 888-762-9030
  • Fax: 714-445-0245
Mailing address:
  • Phone: 888-762-9030
  • Fax: 714-445-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM LYNN KUHL
Title or Position: VP OPERATIONS
Credential:
Phone: 714-445-0236