Provider Demographics
NPI:1710133814
Name:CHRISTOPHER E. CLEVENGER, M.D., INC.
Entity Type:Organization
Organization Name:CHRISTOPHER E. CLEVENGER, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MIKAZUKI
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAMIMURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-648-3361
Mailing Address - Street 1:980 CASS ST
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-4548
Mailing Address - Country:US
Mailing Address - Phone:831-648-3361
Mailing Address - Fax:
Practice Address - Street 1:980 CASS ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4548
Practice Address - Country:US
Practice Address - Phone:831-648-3361
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG84499207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG73204Medicare UPIN
CA00G844990Medicare PIN