Provider Demographics
NPI:1629327770
Name:SEASIDE NEPHROLOGY, INC
Entity Type:Organization
Organization Name:SEASIDE NEPHROLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAING
Authorized Official - Middle Name:TUN
Authorized Official - Last Name:KYAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-967-9900
Mailing Address - Street 1:3300 VISTA WAY STE B
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-3633
Mailing Address - Country:US
Mailing Address - Phone:760-967-9900
Mailing Address - Fax:
Practice Address - Street 1:3300 VISTA WAY STE B
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-3633
Practice Address - Country:US
Practice Address - Phone:760-967-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97469207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I 71031Medicare UPIN