Provider Demographics
NPI:1710085154
Name:NORTHERN CALIFORNIA KIDNEY STONE CENTER INC
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA KIDNEY STONE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLI
Authorized Official - Middle Name:
Authorized Official - Last Name:MOAYED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-358-2805
Mailing Address - Street 1:16400 LARK AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032
Mailing Address - Country:US
Mailing Address - Phone:408-358-2805
Mailing Address - Fax:408-358-2810
Practice Address - Street 1:16400 LARK AVE
Practice Address - Street 2:STE 100
Practice Address - City:LAS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032
Practice Address - Country:US
Practice Address - Phone:408-358-2805
Practice Address - Fax:408-358-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ98369ZMedicare ID - Type Unspecified