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General NPI Number Information
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NPI Number | 1518016773
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Entity Type | Organization
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Legal Business Name | KIDNEY CENTER A MEDICAL GROUP INC
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/28/2015
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Provider Practice Location Address
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Address Line | 3543 SAN DIMAS ST SUITE B
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City | BAKERSFIELD
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State | CA
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Zip | 93301-1605
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Country | US
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Telephone | 661-869-2600
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Fax | 661-869-2003
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Provider Business Mailing Address
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Address Line | PO BOX 11959
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City | BAKERSFIELD
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State | CA
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Zip | 93389-3959
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Country | US
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Telephone | 661-869-2600
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Fax | 661-869-2003
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Authorized Official
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Title or Position | OWNER OPERATOR
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Name | CAROLINE WONG
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Credential | MD
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Telephone | 661-869-2600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | G75701
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | G75701
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License Number State | CA
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