Healthcare Provider Details

I. General information

NPI: 1508060211
Provider Name (Legal Business Name): JOHN J. KANE, M.D.,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE 301
RIVERSIDE CA
92506-0102
US

IV. Provider business mailing address

4646 BROCKTON AVE 301
RIVERSIDE CA
92506-0102
US

V. Phone/Fax

Practice location:
  • Phone: 951-774-2932
  • Fax: 951-774-2935
Mailing address:
  • Phone: 951-774-2932
  • Fax: 951-774-2935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG28777
License Number StateCA

VIII. Authorized Official

Name: JOHN J KANE
Title or Position: M.D.
Credential: M.D.
Phone: 951-774-2932