Nathan a. Kludt, MD, Inc

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

A110013 Issued in CA

Legal business name

NATHAN A. KLUDT, MD, INC

Doing business as

Plastic Surgery Center of Stockton

Practice address

1805 N California St Ste 405
Stockton, CA 95204-6033

Phone

(209) 870-7100

Fax

(209) 870-7116

NPI assigned

Jun 16, 2016

Last updated

Jun 16, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Nathan Andrew Kludt, MDNPI 1841457355

Title

President

Phone

(209) 870-7100

Specialties & licenses 1

Addresses

Other names 1

• Plastic Surgery Center of Stockton Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Nathan Andrew Kludt, MD

  • Plastic Surgery Physician
  • Stockton, CA
  • NPI 1841457355
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1144670597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 N CALIFORNIA ST STE 405",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046033",
            "telephone_number": "209-870-7100",
            "fax_number": "209-870-7116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 N CALIFORNIA ST STE 405",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952046033",
            "telephone_number": "209-870-7100",
            "fax_number": "209-870-7116"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATHAN A. KLUDT, MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-16",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "KLUDT",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-870-7100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "CA",
            "license": "A110013",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Plastic Surgery Center of Stockton",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Medical Specialty Clinic/Center in Stockton, CA
• Providers in Stockton, CA by specialty
• Medical Specialty Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.