Healthcare Provider Details

I. General information

NPI: 1376709352
Provider Name (Legal Business Name): JAMES G. KALKANIS, MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 MAGNOLIA AVE SUITE 206
CORONA CA
92879-3332
US

IV. Provider business mailing address

341 MAGNOLIA AVE SUITE 206
CORONA CA
92879-3332
US

V. Phone/Fax

Practice location:
  • Phone: 951-735-0470
  • Fax: 951-735-2842
Mailing address:
  • Phone: 951-735-0470
  • Fax: 951-735-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES GEORGE KALKANIS
Title or Position: OWNER
Credential: M.D.
Phone: 951-735-0470