Provider Demographics
NPI:1649238163
Name:KIRALY, JOHN F III (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:KIRALY
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1599
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:95258-1599
Mailing Address - Country:US
Mailing Address - Phone:209-269-0860
Mailing Address - Fax:209-368-6425
Practice Address - Street 1:19509 BENEDICT DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:CA
Practice Address - Zip Code:95258-9050
Practice Address - Country:US
Practice Address - Phone:209-269-0860
Practice Address - Fax:209-368-6425
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1669669586OtherMEDICARE DSHO
CA00A241900Medicaid
A23486Medicare UPIN
CA00A241900Medicaid