Provider Demographics
NPI:1700134103
Name:KNEE CENTERS NOCAL MEDICAL PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:KNEE CENTERS NOCAL MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-504-8151
Mailing Address - Street 1:585 W 500 S
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8199
Mailing Address - Country:US
Mailing Address - Phone:801-617-2100
Mailing Address - Fax:801-208-7050
Practice Address - Street 1:2675 STEVENSON BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2317
Practice Address - Country:US
Practice Address - Phone:510-791-5633
Practice Address - Fax:510-791-5634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA783912081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty