# CALIFORNIA KIDNEY MEDICAL GROUP INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1659537835
- **Authorized official:** MRS. LILY KRASTEIN (ADMINISTRATOR)
- **Authorized official phone:** (805) 433-7507

## Contact information

- **Practice address:** 18546 ROSCOE BLVD, SUITE 120, NORTHRIDGE, CA 91324-4663
- **Practice address phone:** (818) 886-3773
- **Mailing address:** PO BOX 940838, SIMI VALLEY, CA 93094-0838
- **Mailing address phone:** (805) 433-7507

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | G83840 | CA | Yes |

## Other

- **Enumeration date:** 08/06/2008
- **Last updated:** 08/06/2008