Provider Demographics
NPI:1396863973
Name:SERGE KASKA, M.D., INC.
Entity Type:Organization
Organization Name:SERGE KASKA, M.D., INC.
Other - Org Name:KASKA ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KASKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-750-1902
Mailing Address - Street 1:277 RANCHEROS DR.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069
Mailing Address - Country:US
Mailing Address - Phone:760-750-1902
Mailing Address - Fax:760-750-1906
Practice Address - Street 1:277 RANCHEROS DR.
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069
Practice Address - Country:US
Practice Address - Phone:760-750-1902
Practice Address - Fax:760-750-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2016-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73685207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A736850Medicaid
CAA73685OtherMEDICAL LICENSE
CAI05163Medicare UPIN
CA00A736850Medicaid