Provider Demographics
NPI:1083915698
Name:JAMES P KRIEG M D MEDICAL CORP
Entity Type:Organization
Organization Name:JAMES P KRIEG M D MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRIEG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-672-1911
Mailing Address - Street 1:29826 HAUN ROAD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:MENIFEE SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586
Mailing Address - Country:US
Mailing Address - Phone:951-672-1911
Mailing Address - Fax:951-672-8406
Practice Address - Street 1:29826 HAUN ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:MENIFEE SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586
Practice Address - Country:US
Practice Address - Phone:951-672-1911
Practice Address - Fax:951-672-8406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42427207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48959Medicare UPIN