NPIMap

Organization Active NPI

Diablo Infectious Disease Consultative Service Med GRP Inc

  • Infectious Disease Physician
  • San Leandro, CA
National Provider Identifier
1952376535
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
DIABLO INFECTIOUS DISEASE CONSULTATIVE SERVICE MED GRP INC
Practice address
13851 E 14TH St Ste 308
San Leandro, CA 94578-2630
Phone
(925) 463-1318
NPI assigned
Feb 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

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

Authorized official

Name
Li Kuo Kong, MD
Title
President
Phone
(925) 463-1318

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RI0200X Primary

Addresses

Primary practice location

13851 E 14TH St Ste 308
San Leandro, CA 94578-2630

Mailing address

PO Box 20309
Castro Valley, CA 94546-8309
Phone (925) 463-1318

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040924000239 CA Part B Supplier - Clinic/Group Practice 9032187281 Receives reassigned benefits from 20 practitioners
Practice locations: San Leandro, CA

National Provider Directory

National Provider Directory

Locations

5565 W Las Positas Blvd
Ste 225
Pleasanton, CA 94588
Phone (310) 480-3232

13855 E 14th St
Ste 308
San Leandro, CA 94578

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1140134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1690156800000",
    "number": "1952376535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20309",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945468309",
            "telephone_number": "925-463-1318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13851 E 14TH ST STE 308",
            "city": "SAN LEANDRO",
            "state": "CA",
            "postal_code": "945782630",
            "telephone_number": "925-463-1318"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABLO INFECTIOUS DISEASE CONSULTATIVE SERVICE MED GRP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-17",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A",
        "authorized_official_last_name": "KONG",
        "authorized_official_first_name": "LI",
        "authorized_official_middle_name": "KUO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "925-463-1318",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Leandro, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; 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.