Provider Demographics
NPI:1356490288
Name:JANE F. KARDASHIAN, M.D., INC.
Entity Type:Organization
Organization Name:JANE F. KARDASHIAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:F
Authorized Official - Last Name:KARDASHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-435-0337
Mailing Address - Street 1:6769 N FRESNO ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-3715
Mailing Address - Country:US
Mailing Address - Phone:559-435-0337
Mailing Address - Fax:559-435-2918
Practice Address - Street 1:6769 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-3715
Practice Address - Country:US
Practice Address - Phone:559-435-0337
Practice Address - Fax:559-435-2918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43958261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49505Medicare UPIN
CA00G439580Medicare ID - Type Unspecified