Organization
KIDNEY CARE SERVICES OF HUMBOLDT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES LEE WYNN JR. (ADMIN AIDE)
(707) 362-8769
Entity
Organization
Contact information
Practice address
1651 MYRTLE AVE STE C, EUREKA, CA 95501-1495
(707) 599-6700
(888) 475-8698
Mailing address
1651 MYRTLE AVE STE C, EUREKA, CA 95501-1495
(707) 599-6700
(888) 475-8698
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
23313
CA
261QH0100X
Health Service Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
332900000X
Non-Pharmacy Dispensing Site
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
RN846580
—
CA
Enumeration date
07/04/2015
Last updated
04/30/2024
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