Provider Demographics
NPI:1295258341
Name:PACIFIC NEPHROLOGY ASSOCIATES MEDICAL GROUP, PC
Entity type:Organization
Organization Name:PACIFIC NEPHROLOGY ASSOCIATES MEDICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:KUHL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-445-0236
Mailing Address - Street 1:3080 BRISTOL ST STE 600
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-7341
Mailing Address - Country:US
Mailing Address - Phone:888-762-9030
Mailing Address - Fax:714-445-0245
Practice Address - Street 1:1211 W LA PALMA AVE STE 102
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2809
Practice Address - Country:US
Practice Address - Phone:888-762-9030
Practice Address - Fax:714-445-0245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty