=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023135464
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JAMES J KRUEGER, MD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2007
-----------------------------------------------------
Last Update Date | 02/13/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 701 E 28TH ST 400
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90806-2759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-424-6040
-----------------------------------------------------
Fax | 562-427-2565
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 749
-----------------------------------------------------
City | HUNTINGTON BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92648-0749
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-424-6040
-----------------------------------------------------
Fax | 562-427-2565
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMES JEROME KRUEGER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 562-424-6040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A45160
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------