Healthcare Provider Details

I. General information

NPI: 1649459025
Provider Name (Legal Business Name): JERRY H. KAYE, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2007
Last Update Date: 11/01/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 W JANSS RD SUITE 110
THOUSAND OAKS CA
91360-1848
US

IV. Provider business mailing address

1394 DORAL CIR
WESTLAKE VILLAGE CA
91362-4370
US

V. Phone/Fax

Practice location:
  • Phone: 805-496-6051
  • Fax:
Mailing address:
  • Phone: 805-496-6051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberC31187
License Number StateCA

VIII. Authorized Official

Name: DR. JERRY H. KAYE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 805-496-6051