California Kidney Medical Group Inc

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

CALIFORNIA KIDNEY MEDICAL GROUP INC

Practice address

227 W Janss Rd
Suite 110
Thousand Oaks, CA 91360-1848

Phone

(805) 496-6051

Fax

(805) 496-6785

NPI assigned

Aug 31, 2006

Reactivated

Jul 29, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lily Krastein

Title

Administrator

Phone

(805) 433-7777

Specialties & licenses 1

Addresses

Other identifiers 1

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/BADGAA

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1083726871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 940838",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930940838",
            "telephone_number": "805-433-7777",
            "fax_number": "805-433-7607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "227 W JANSS RD",
            "address_2": "SUITE 110",
            "city": "THOUSAND OAKS",
            "state": "CA",
            "postal_code": "913601848",
            "telephone_number": "805-496-6051",
            "fax_number": "805-496-6785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALIFORNIA KIDNEY MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2008-07-29",
        "deactivation_date": "2007-08-21",
        "reactivation_date": "2008-07-29",
        "status": "A",
        "authorized_official_last_name": "KRASTEIN",
        "authorized_official_first_name": "LILY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "805-433-7777"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0087560",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Nephrology Physician in Thousand Oaks, CA
• Providers in Thousand Oaks, CA by specialty
• Nephrology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.