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General NPI Number Information
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NPI Number | 1891235578
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Entity Type | Organization
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Legal Business Name | SOUTH COUNTY KIDNEY AND ENDOCRINE CENTER
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 23141 MOULTON PKWY STE 102
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-1241
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Country | US
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Telephone | 949-916-9100
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Fax | 949-916-0091
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Provider Business Mailing Address
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Address Line | 23141 MOULTON PKWY #102
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City | LAGUNA HILLS
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State | CA
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Zip | 92653
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Country | US
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Telephone | 949-916-9100
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Fax | 949-916-0091
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RAYMOND KU JAY CHANG
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Credential |
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Telephone | 949-916-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number | 202278889
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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