California Kidney Medical Group, Inc
Organization Active NPI Nephrology Physician · Moorpark, CA
NPI 1760586705 · NPPES record last updated Nov 30, 2016
Key facts
- NPI
- 1760586705
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nephrology Physician 207RN0300X
- Legal business name
- CALIFORNIA KIDNEY MEDICAL GROUP, INC
- Practice address
- 13990 Bear Fence CT
Moorpark, CA 93021-5022 - Phone
- (818) 718-2301
- Fax
- (818) 718-2311
- NPI assigned
- Sep 11, 2006
- Organization subpart
- No
Authorized official
- Name
- Joyce Van Bruck
- Title
- Administrator
- Phone
- (818) 400-6396
Practitioners 6
-
Edgar Allan Musngi, M.D.
-
Hamid Sadeghi, M.D.
-
Salah Sonbol, M.D.
-
Jie Shi Yan, M.D.
-
Shashank Kailash, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031118000343 | CA | Part B Supplier - Clinic/Group Practice | 2769396357 |
Receives reassigned benefits from 6 practitioners Practice locations: Los Angeles, CA; Thousand Oaks, CA; Panorama City, CA; Simi Valley, CA |
National Provider Directory
Locations
14860 Roscoe Blvd
Ste 303
Panorama City, CA 91402
Phone (818) 376-4074
Networks
- BSC 65 PLUS INDIVIDUAL MAPD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician |
207RN0300X | Yes |
Addresses
Primary practice location
13990 Bear Fence CT
Moorpark, CA 93021-5022
Mailing address
PO Box 2160
Moorpark, CA 93020-2160
Phone (818) 718-2301
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0087560 | Medicaid | CA |
Other providers in Moorpark, CA
- Carrie Burgert
- Burts Pharmacy Moorpark
- Burts Pharmacy Moorpark
- Ca Ya Services LLC
- Ca Ya Services LLC
- Liliana Camacho
- Marie Campbell
- Katrina Camus
- David Canale
- Kimberly Cano
All providers in Moorpark, CA · Nephrology Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.