Provider Demographics
NPI:1063462950
Name:NEPHROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-526-2027
Mailing Address - Street 1:2301 CIRCADIAN WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-5416
Mailing Address - Country:US
Mailing Address - Phone:707-526-2027
Mailing Address - Fax:707-526-2096
Practice Address - Street 1:2301 CIRCADIAN WAY
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-5416
Practice Address - Country:US
Practice Address - Phone:707-526-2027
Practice Address - Fax:707-526-2096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0058950Medicaid
CAGR0058950Medicaid
ZZZ25299ZMedicare PIN