Provider Demographics
NPI:1326133448
Name:PACIFIC RENAL CARE MEDICAL CORP
Entity Type:Organization
Organization Name:PACIFIC RENAL CARE MEDICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOGINDER
Authorized Official - Middle Name:S
Authorized Official - Last Name:JODHKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-241-9200
Mailing Address - Street 1:PO BOX 20230
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-0230
Mailing Address - Country:US
Mailing Address - Phone:714-241-9200
Mailing Address - Fax:
Practice Address - Street 1:11180 WARNER AVE STE 463
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7505
Practice Address - Country:US
Practice Address - Phone:714-241-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2017-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty