Provider Demographics
NPI:1760504435
Name:NEXUS HEALTHCARE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:NEXUS HEALTHCARE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:K
Authorized Official - Last Name:KANKAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-607-1803
Mailing Address - Street 1:3407 S MOONEY BLVD
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-7773
Mailing Address - Country:US
Mailing Address - Phone:559-553-4550
Mailing Address - Fax:
Practice Address - Street 1:3407 S MOONEY BLVD
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-7773
Practice Address - Country:US
Practice Address - Phone:559-553-4550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP1685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherELECTRONIC CLAIMS ID