MEDICARE: DR. KG ROMINE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	C37437	CA

General Provider Information

NPI Number	:	1225441033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KG ROMINE M.D.

Provider Business Mailing Address
First Line	:	5482 BOBBYWOOD AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-6144
Country	:	US
Telephone Number	:	408-691-0070
Fax Number	:

Provider Business Practice Location Address
First Line	:	5482 BOBBYWOOD AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95124-6144
Country	:	US
Telephone Number	:	408-691-0070
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2014
Last Update Date	:	06/10/2014

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