Provider Demographics
NPI:1073602470
Name:KERN GASTROENTEROLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:KERN GASTROENTEROLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:OSBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-324-1203
Mailing Address - Street 1:5959 TRUXTUN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0437
Mailing Address - Country:US
Mailing Address - Phone:661-324-1203
Mailing Address - Fax:661-324-3195
Practice Address - Street 1:5959 TRUXTUN AVE STE 200
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0437
Practice Address - Country:US
Practice Address - Phone:661-324-1203
Practice Address - Fax:661-324-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0103330Medicaid
CAGR0103330Medicaid