Provider Demographics
NPI:1790109130
Name:KERN RADIOLOGY MEDICAL GROUP
Entity Type:Organization
Organization Name:KERN RADIOLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MAURICE
Authorized Official - Last Name:GUNDZK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-395-3272
Mailing Address - Street 1:2301 BAHAMAS DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0663
Mailing Address - Country:US
Mailing Address - Phone:661-326-9600
Mailing Address - Fax:661-334-3065
Practice Address - Street 1:1427 S LEXINGTON ST
Practice Address - Street 2:BUILDING A, SUITE 10
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-9273
Practice Address - Country:US
Practice Address - Phone:661-326-9600
Practice Address - Fax:661-334-3065
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty