Healthcare Provider Details

I. General information

NPI: 1356658652
Provider Name (Legal Business Name): KAISER GROUP OF MEDICAL CLINICS AND RESIDENTIAL FACILITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 05/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAURU LOOP ST. MARIANS BUSINESS PLAZA 4TH FLOOR ROOM 402
SAIPAN MP
96950-2213
US

IV. Provider business mailing address

P.O. BOX 502213 MARIANAS BUSINESS PLAZA BLDG, ROOM 402, NAURU LOOP ST
SAIPAN MP
96950-2213
US

V. Phone/Fax

Practice location:
  • Phone: 670-234-8005
  • Fax: 670-234-8028
Mailing address:
  • Phone: 670-234-8005
  • Fax: 670-234-8028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number17362-0002-1
License Number StateMP

VIII. Authorized Official

Name: DR. JOHNNY Y FONG
Title or Position: PRESIDENT
Credential: MD
Phone: 670-234-8005