Provider Demographics
NPI:1922179050
Name:KERN ALLERGY MEDICAL CLINIC, INC.
Entity Type:Organization
Organization Name:KERN ALLERGY MEDICAL CLINIC, INC.
Other - Org Name:TONNY TANUS MD MEDICAL CORP. INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TONNY
Authorized Official - Middle Name:
Authorized Official - Last Name:TANUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-327-9693
Mailing Address - Street 1:PO BOX 40702
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93384-0702
Mailing Address - Country:US
Mailing Address - Phone:661-327-9693
Mailing Address - Fax:661-327-0749
Practice Address - Street 1:2121 17TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3704
Practice Address - Country:US
Practice Address - Phone:661-327-9693
Practice Address - Fax:661-327-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-12
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79901207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G799011Medicare ID - Type Unspecified