Provider Demographics
NPI:1932564242
Name:JOHN F. KIRALY III, MD
Entity Type:Organization
Organization Name:JOHN F. KIRALY III, MD
Other - Org Name:STOCKTON HEMATOLOGY ONCOLOGY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FLORIAN
Authorized Official - Last Name:KIRALY
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:209-466-2626
Mailing Address - Street 1:2626 N CALIFORNIA ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-5500
Mailing Address - Country:US
Mailing Address - Phone:209-466-2626
Mailing Address - Fax:209-466-7153
Practice Address - Street 1:801 S HAM LN
Practice Address - Street 2:SUITE S
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-7501
Practice Address - Country:US
Practice Address - Phone:209-366-2616
Practice Address - Fax:209-333-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23846Medicare UPIN
CA00A241900Medicare PIN