Provider Demographics
NPI:1700857976
Name:MCKAY, DIANNE B (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:B
Last Name:MCKAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:FILE# 54433
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:858-784-5906
Mailing Address - Fax:858-784-5933
Practice Address - Street 1:10666 N TORREY PINES RD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1027
Practice Address - Country:US
Practice Address - Phone:858-784-9716
Practice Address - Fax:858-784-5933
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG86376207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G863760Medicaid
390008515OtherRAILROAD MEDICARE
00G863760OtherBLUE SHIELD CA
F770OtherCHAMPUS
390008515OtherRAILROAD MEDICARE
F770OtherCHAMPUS