Healthcare Provider Details

I. General information

NPI: 1962454140
Provider Name (Legal Business Name): KERN NEPHROLOGY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 OFFICE PARK DR
BAKERSFIELD CA
93309-0612
US

IV. Provider business mailing address

5030 OFFICE PARK DR
BAKERSFIELD CA
93309-0612
US

V. Phone/Fax

Practice location:
  • Phone: 661-323-2847
  • Fax: 661-323-2261
Mailing address:
  • Phone: 661-323-2847
  • Fax: 661-323-2261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA35716
License Number StateCA

VIII. Authorized Official

Name: DR. UMAMAHESWARA RAO VARANASI
Title or Position: PARTNER
Credential: M.D.
Phone: 661-323-2847