Provider Demographics
NPI:1447200126
Name:NEPHROLOGY ASSOCIATES MEDICAL GROUP INC
Entity Type:Organization
Organization Name:NEPHROLOGY ASSOCIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAO
Authorized Official - Middle Name:HUANG
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-687-2800
Mailing Address - Street 1:3660 PARK SIERRA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3071
Mailing Address - Country:US
Mailing Address - Phone:951-687-3400
Mailing Address - Fax:951-687-7630
Practice Address - Street 1:3660 PARK SIERRA DR
Practice Address - Street 2:STE 203
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3081
Practice Address - Country:US
Practice Address - Phone:951-687-3400
Practice Address - Fax:951-687-7630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0071420Medicaid
CAGR0071423Medicaid
CAGR0071424Medicaid
CA1447200126Medicaid
CAGR0071422Medicaid
CAGR0071421Medicaid
CAZZZ13165ZMedicare PIN
CAGR0071423Medicaid
CAGR0071424Medicaid
CAGR0071420Medicaid
CAZZZ13211ZMedicare PIN