Provider Demographics
NPI:1669762357
Name:KREMSKY MEDICAL GROUP, INC
Entity type:Organization
Organization Name:KREMSKY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:S
Authorized Official - Last Name:KREMSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-316-8847
Mailing Address - Street 1:10102 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-5415
Mailing Address - Country:US
Mailing Address - Phone:714-316-8847
Mailing Address - Fax:714-968-4682
Practice Address - Street 1:10102 BEVERLY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-5415
Practice Address - Country:US
Practice Address - Phone:714-316-8847
Practice Address - Fax:714-968-4682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47581174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty