Provider Demographics
NPI:1649459025
Name:JERRY H. KAYE, M.D., INC.
Entity type:Organization
Organization Name:JERRY H. KAYE, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:H
Authorized Official - Last Name:KAYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-496-6051
Mailing Address - Street 1:1394 DORAL CIR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4370
Mailing Address - Country:US
Mailing Address - Phone:805-496-6051
Mailing Address - Fax:
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-496-6051
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC31187207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA34475Medicare UPIN
CAW17982Medicare PIN