Organization
CALIFORNIA KIDNEY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LILY KRASTEIN (ADMINISTRATOR)
(805) 433-7777
Entity
Organization
Contact information
Practice address
227 W JANSS RD, SUITE 110, THOUSAND OAKS, CA 91360-1848
(805) 496-6051
(805) 496-6785
Mailing address
PO BOX 940838, SIMI VALLEY, CA 93094-0838
(805) 433-7777
(805) 433-7607
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0087560
—
CA
Enumeration date
08/31/2006
Last updated
07/29/2008
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