Organization Active NPI

R Sankaram M D a Medical Corporation

  • Nephrology Physician
  • Fountain Valley, CA
National Provider Identifier
1750675286
Registry record updated Jun 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
A25687 Issued in CA
Legal business name
R SANKARAM M D A MEDICAL CORPORATION
Practice address
11100 Warner Ave
Suite 260
Fountain Valley, CA 92708-7506
Phone
(714) 641-6900
Fax
(714) 641-3900
NPI assigned
Jun 1, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2025

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

Authorized official

Name
Celine Duong
Title
Administration Manager
Phone
(714) 721-0848

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nephrology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RN0300X A25687 CA Primary

Addresses

Primary practice location

11100 Warner Ave
Suite 260
Fountain Valley, CA 92708-7506

Mailing address

62 Modena
Irvine, CA 92618-0104
Phone (714) 721-0848

Other identifiers 1

IdentifierTypeStateIssuer
00A256871MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110714000364 CA Part B Supplier - Clinic/Group Practice 5890963037 Receives reassigned benefits from 1 practitioner
Practice locations: Irvine, CA

National Provider Directory

National Provider Directory

Locations

11100 Warner Ave
Ste 260
Fountain Vly, CA 92708
Phone (714) 641-6900

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1306886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749168000000",
    "number": "1750675286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "62 MODENA",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926180104",
            "telephone_number": "714-721-0848",
            "fax_number": "949-387-2500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11100 WARNER AVE",
            "address_2": "SUITE 260",
            "city": "FOUNTAIN VALLEY",
            "state": "CA",
            "postal_code": "927087506",
            "telephone_number": "714-641-6900",
            "fax_number": "714-641-3900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R SANKARAM M D A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-01",
        "last_updated": "2025-06-06",
        "certification_date": "2025-06-06",
        "status": "A",
        "authorized_official_last_name": "DUONG",
        "authorized_official_first_name": "CELINE",
        "authorized_official_title_or_position": "ADMINISTRATION MANAGER",
        "authorized_official_telephone_number": "714-721-0848"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "CA",
            "license": "A25687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A256871",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fountain Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2025; 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.