Healthcare Provider Details

I. General information

NPI: 1093264145
Provider Name (Legal Business Name): NEPHROLOGY ASSOCIATES MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3660 PARK SIERRA DR STE 203
RIVERSIDE CA
92505-3071
US

IV. Provider business mailing address

PO BOX 54130
LOS ANGELES CA
90054-0130
US

V. Phone/Fax

Practice location:
  • Phone: 951-687-3200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHAO HUANG SUN
Title or Position: CO OWNER
Credential:
Phone: 951-687-3200