Provider Demographics
NPI:1225015944
Name:BEACH CITIES NEPHROLOGY
Entity Type:Organization
Organization Name:BEACH CITIES NEPHROLOGY
Other - Org Name:BEACH CITIES NEPHROLOGY MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:INADOMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-542-7997
Mailing Address - Street 1:20911 EARL STREET
Mailing Address - Street 2:SUITE 320
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-542-7997
Mailing Address - Fax:310-542-2607
Practice Address - Street 1:20911 EARL STREET
Practice Address - Street 2:SUITE 320
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503
Practice Address - Country:US
Practice Address - Phone:310-542-7997
Practice Address - Fax:310-542-2607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG6215207RN0300X
207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0049450Medicaid
CAGR0049450Medicaid