Provider Demographics
NPI:1003124975
Name:KAISER GROUP OF MEDICAL CLINICS & RESIDENTIAL FACILITIES, INC.
Entity Type:Organization
Organization Name:KAISER GROUP OF MEDICAL CLINICS & RESIDENTIAL FACILITIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:YEE
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:670-234-8005
Mailing Address - Street 1:MARIANAS BUSINESS PLAZA BUILDING ROOM 402
Mailing Address - Street 2:NAURU LOOP ST., P.O. BOX 503570
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-3570
Mailing Address - Country:US
Mailing Address - Phone:670-234-8005
Mailing Address - Fax:670-234-8028
Practice Address - Street 1:NAURU LOOP ST, MARIANAS BUSINESS PLAZA
Practice Address - Street 2:4TH FLOOR, RM 402
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-3570
Practice Address - Country:US
Practice Address - Phone:670-234-8005
Practice Address - Fax:670-234-8028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP17362-0002-1261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty