Healthcare Provider Details

I. General information

NPI: 1083698617
Provider Name (Legal Business Name): GEORGE A. KAYSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST NEPHROLOGY DIVISION #3500 PSSB
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

451 EAST HEALTH SCIENCES DRIVE ONE SHIELDS AVE
DAVIS CA
95616
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-3014
  • Fax: 916-734-7920
Mailing address:
  • Phone: 530-752-2970
  • Fax: 530-752-3791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberG033653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: