Provider Demographics
NPI:1376926626
Name:HEALTHCARE & KIDNEY CLINIC A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HEALTHCARE & KIDNEY CLINIC A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:YE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-361-5983
Mailing Address - Street 1:2736 SALISBURY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-5769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:929 CLAY ST
Practice Address - Street 2:302
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1556
Practice Address - Country:US
Practice Address - Phone:415-361-5086
Practice Address - Fax:415-216-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-06
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X, 261QM2500X
CA20A10714261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A10714OtherOSTEOPATHIC PHYSICIAN AND SURGEON