Central Valley ENT Medical Group Inc

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

CENTRAL VALLEY ENT MEDICAL GROUP INC

Practice address

1600 Sunrise Ave
Suite 16
Modesto, CA 95350-4679

Phone

(209) 524-6681

Fax

(209) 524-2962

NPI assigned

Aug 30, 2006

Organization subpart

No

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

Authorized official

Name

Thomas Edward Killeen, M.D.

Title

President

Phone

(209) 524-6681

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447369566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 SUNRISE AVE",
            "address_2": "SUITE 16",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504679",
            "telephone_number": "209-524-6681",
            "fax_number": "209-524-2962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 SUNRISE AVE",
            "address_2": "SUITE 16",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953504679",
            "telephone_number": "209-524-6681",
            "fax_number": "209-524-2962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL VALLEY ENT MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KILLEEN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-524-6681",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "ZZZ73209Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Modesto, CA
• Providers in Modesto, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.