Provider Demographics
NPI:1356431233
Name:RANCHO VALLEY ORTHOPAEDIC SURGERY MEDICAL CLINIC INC
Entity type:Organization
Organization Name:RANCHO VALLEY ORTHOPAEDIC SURGERY MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-699-4472
Mailing Address - Street 1:29373 RANCHO CALIF RD
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5201
Mailing Address - Country:US
Mailing Address - Phone:951-699-4472
Mailing Address - Fax:951-694-8424
Practice Address - Street 1:29373 RANCHO CALIF RD
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5201
Practice Address - Country:US
Practice Address - Phone:951-699-4472
Practice Address - Fax:951-694-8424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23360ZMedicare PIN