Healthcare Provider Details

I. General information

NPI: 1033404306
Provider Name (Legal Business Name): MSK-US, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2011
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4215 SPRING ST SUITE 125
LA MESA CA
91941-7965
US

IV. Provider business mailing address

4215 SPRING ST SUITE 125
LA MESA CA
91941-7965
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-7277
  • Fax: 619-461-7278
Mailing address:
  • Phone: 619-461-7277
  • Fax: 619-461-7278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY A. KREIFELDT
Title or Position: CORP SECRETARY
Credential: MS, PA-C
Phone: 619-804-7627