Provider Demographics
NPI:1679828776
Name:REEN MEDICAL GROUP INC
Entity Type:Organization
Organization Name:REEN MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIKJIT
Authorized Official - Middle Name:S
Authorized Official - Last Name:REEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-552-0967
Mailing Address - Street 1:1525 N NORMA ST STE B
Mailing Address - Street 2:
Mailing Address - City:RIDGECREST
Mailing Address - State:CA
Mailing Address - Zip Code:93555-6536
Mailing Address - Country:US
Mailing Address - Phone:760-463-1613
Mailing Address - Fax:760-463-1614
Practice Address - Street 1:1525 N NORMA ST STE B
Practice Address - Street 2:
Practice Address - City:RIDGECREST
Practice Address - State:CA
Practice Address - Zip Code:93555-6536
Practice Address - Country:US
Practice Address - Phone:760-463-1613
Practice Address - Fax:760-463-1614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CL440AOtherPTAN