Provider Demographics
NPI:1750526257
Name:OCEANSIDE PEDIATRICS
Entity type:Organization
Organization Name:OCEANSIDE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:KILUK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-622-4448
Mailing Address - Street 1:3701 JOHN PLATT DR
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-4372
Mailing Address - Country:US
Mailing Address - Phone:252-622-4448
Mailing Address - Fax:252-622-4014
Practice Address - Street 1:3701 JOHN PLATT DR
Practice Address - Street 2:
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4372
Practice Address - Country:US
Practice Address - Phone:252-622-4448
Practice Address - Fax:252-622-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-11
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC153474208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty