MEDICARE: KREMSKY MEDICAL GROUP, INC

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	174400000X	Specialist	G47581	CA

General Provider Information

NPI Number	:	1669762357
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KREMSKY MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	10102 BEVERLY DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-5415
Country	:	US
Telephone Number	:	714-316-8847
Fax Number	:	714-968-4682

Provider Business Practice Location Address
First Line	:	10102 BEVERLY DR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92646-5415
Country	:	US
Telephone Number	:	714-316-8847
Fax Number	:	714-968-4682

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STANTON S KREMSKY
Credential	:	MD
Telephone Number	:	714-316-8847

Provider Enumeration Date	:	04/14/2011
Last Update Date	:	04/14/2011

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