Healthcare Provider Details

I. General information

NPI: 1023135464
Provider Name (Legal Business Name): JAMES J KRUEGER, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST 400
LONG BEACH CA
90806-2759
US

IV. Provider business mailing address

PO BOX 749
HUNTINGTON BEACH CA
92648-0749
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-6040
  • Fax: 562-427-2565
Mailing address:
  • Phone: 562-424-6040
  • Fax: 562-427-2565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA45160
License Number StateCA

VIII. Authorized Official

Name: DR. JAMES JEROME KRUEGER
Title or Position: OWNER
Credential: M.D.
Phone: 562-424-6040