Healthcare Provider Details

I. General information

NPI: 1740398536
Provider Name (Legal Business Name): KAY MUKERGEE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7392 MAGNOLIA AVE
RIVERSIDE CA
92504-3808
US

IV. Provider business mailing address

7392 MAGNOLIA AVE
RIVERSIDE CA
92504-3808
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-3330
  • Fax: 951-352-3303
Mailing address:
  • Phone: 951-352-3330
  • Fax: 951-352-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA38794
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: