Provider Demographics
NPI:1699394460
Name:BAY AREA KIDNEY CARE MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:BAY AREA KIDNEY CARE MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:CHYN
Authorized Official - Last Name:TSUI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:734-358-8833
Mailing Address - Street 1:39370 MOZART TERRACE UNIT 106
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:734-358-8833
Mailing Address - Fax:972-428-3630
Practice Address - Street 1:39370 MOZART TERRACE UNIT 106
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:734-358-8833
Practice Address - Fax:972-428-3630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942476940Medicaid