Provider Demographics
NPI:1457344475
Name:REGENTS OF THE UNIV OF CA
Entity Type:Organization
Organization Name:REGENTS OF THE UNIV OF CA
Other - Org Name:REGENTS UCD PBG PED RHEUM
Other - Org Type:Other Name
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-734-1166
Mailing Address - Street 1:4900 BROADWAY
Mailing Address - Street 2:STE 2600
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-1532
Mailing Address - Country:US
Mailing Address - Phone:916-734-9200
Mailing Address - Fax:916-734-9661
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-3179
Practice Address - Fax:916-456-2236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric RheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACI4127OtherRAILROAD MEDICARE PIN
CACN4400OtherRAILROAD MEDICARE PIN
CACN4844OtherRAILROAD MEDICARE PIN
CACR0028OtherRAILROAD MEDICARE PIN
CAGNP000070Medicaid
CADA4168OtherRAILROAD MEDICARE PIN
CAGRW021043Medicaid
CAZZZP5701ZOtherMEDICAID/CHDP PIN
CADE7275OtherRAILROAD MEDICARE PIN
CACI4127OtherRAILROAD MEDICARE PIN