Provider Demographics
NPI:1093264145
Name:NEPHROLOGY ASSOCIATES MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAO
Authorized Official - Middle Name:HUANG
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-687-3200
Mailing Address - Street 1:PO BOX 54130
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0130
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3660 PARK SIERRA DR STE 203
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3071
Practice Address - Country:US
Practice Address - Phone:951-687-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-30
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071421Medicaid
CAGR0071424Medicaid
CAGR71423Medicaid
CAGR0071420Medicaid
CAGR0071422Medicaid
CA1447200126Medicaid
CAZZZ13172ZMedicare PIN
CAGR71423Medicaid
CAGR0071422Medicaid
CAMMM00437MMedicare PIN
CAZZZ13211ZMedicare PIN