Healthcare Provider Details

I. General information

NPI: 1477698686
Provider Name (Legal Business Name): KERN COUNTY MEDICAL CLINIC,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 02/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 19TH STREET
BAKERSFIELD CA
93301
US

IV. Provider business mailing address

2222 19TH STREET
BAKERSFIELD CA
93301
US

V. Phone/Fax

Practice location:
  • Phone: 661-325-2448
  • Fax: 661-325-7425
Mailing address:
  • Phone: 661-325-2448
  • Fax: 661-325-7425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberC41262
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberC41262
License Number StateCA

VIII. Authorized Official

Name: SEE RUERN KITT
Title or Position: PHYSICIAN
Credential: MD
Phone: 661-325-2448