Healthcare Provider Details

I. General information

NPI: 1699294025
Provider Name (Legal Business Name): KERN RADIOLOGY MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2017
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 S MILL ST
TEHACHAPI CA
93561-2027
US

IV. Provider business mailing address

2301 BAHAMAS DR
BAKERSFIELD CA
93309-0663
US

V. Phone/Fax

Practice location:
  • Phone: 661-326-9600
  • Fax: 661-334-3065
Mailing address:
  • Phone: 661-326-9600
  • Fax: 661-334-3065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2085R0202X
License Number StateCA

VIII. Authorized Official

Name: MRS. JEROME LYLE STURZ
Title or Position: CEO
Credential:
Phone: 661-326-9600