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Organization
REGENTS OF THE UNIV OF CA
Active
Organization
REGENTS OF THE UNIV OF CA
Active
Other names
Regents UCD PBG PED RHEUM
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES D KIRK MD (CMO)
(916) 734-1166
Entity
Organization
Contact information
Practice address
2521 STOCKTON BLVD, SACRAMENTO, CA 95817-2207
(916) 734-3179
(916) 456-2236
Mailing address
4900 BROADWAY, STE 2600, SACRAMENTO, CA 95820-1532
(916) 734-9200
(916) 734-9661
Taxonomy
Speciality
Code
Description
License number
State
2080P0216X
Pediatric Rheumatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CI4127
RAILROAD MEDICARE PIN
CA
01
—
CN4400
RAILROAD MEDICARE PIN
CA
01
—
CN4844
RAILROAD MEDICARE PIN
CA
01
—
CR0028
RAILROAD MEDICARE PIN
CA
01
—
DA4168
RAILROAD MEDICARE PIN
CA
01
—
DE7275
RAILROAD MEDICARE PIN
CA
05
—
GNP000070
—
CA
05
—
GRW021043
—
CA
01
—
ZZZP5701Z
MEDICAID/CHDP PIN
CA
Enumeration date
08/24/2005
Last updated
03/21/2014
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