Provider Demographics
NPI:1922035203
Name:KERN PHYSICIANS MEDICAL GROUP
Entity Type:Organization
Organization Name:KERN PHYSICIANS MEDICAL GROUP
Other - Org Name:KERN PHYSICIANS MEDICAL GROUP, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAKHRUDDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:611-322-8611
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-0669
Mailing Address - Country:US
Mailing Address - Phone:661-322-8611
Mailing Address - Fax:661-322-8008
Practice Address - Street 1:606 34TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2208
Practice Address - Country:US
Practice Address - Phone:661-322-8611
Practice Address - Fax:661-322-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50871207R00000X
CAA63225207RI0200X
CA20A5922208D00000X
CA20A9285208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Not Answered208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2861245OtherCORPORATE NUMBER
CA2861245OtherCORPORATE NUMBER