# SOUTH COUNTY KIDNEY AND ENDOCRINE CENTER

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

## Provider details

- **NPI number:** 1891235578
- **Authorized official:** DR. RAYMOND KU JAY CHANG (MEDICAL DIRECTOR)
- **Authorized official phone:** (949) 916-9100

## Contact information

- **Practice address:** 23141 MOULTON PKWY STE 102, LAGUNA HILLS, CA 92653-1241
- **Practice address phone:** (949) 916-9100
- **Practice address fax:** (949) 916-0091
- **Mailing address:** 23141 MOULTON PKWY \#102, LAGUNA HILLS, CA 92653
- **Mailing address phone:** (949) 916-9100
- **Mailing address fax:** (949) 916-0091

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251K00000X | Public Health or Welfare Agency | 202278889 | CA | — |
| 251K00000X | Public Health or Welfare Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 03/01/2017
- **Last updated:** 03/01/2017