CALIFORNIA KIDNEY MEDICAL GROUP INC (NPI# 1659537835) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659537835 |
| Entity Type | Organization |
| Organization Name | CALIFORNIA KIDNEY MEDICAL GROUP INC |
| Practice Address |
18546 Roscoe Blvd Suite 120 Northridge CA 91324-4663 |
| Mailing Address |
Po Box 940838 Simi Valley CA 93094-0838 |
| Practice Telephone | 8188863773 |
| Mailing Telephone | 8054337507 |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2008-08-06 |
| Authorized Official Name | MRS. LILY KRASTEIN (ADMINISTRATOR) |
| Authorized Official Telephone | 8054337507 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
G83840 | CA | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649291774 | California Kidney Medical Group Inc | Clinical Medical Laboratory | 50 Moreland Rd, Simi Valley, CA 93065-1659 | 2006-07-22 |
| 1083726871 | California Kidney Medical Group Inc | Internal Medicine | 227 W Janss Rd, Suite 110, Thousand Oaks, CA 91360-1848 | 2006-08-31 |
| Street Address |
18546 ROSCOE BLVD SUITE 120 |
| City | NORTHRIDGE |
| State | CA |
| Zip Code | 91324-4663 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730177932 | Lawrence Osman | Dermatology | 18546 Roscoe Blvd, Ste 306, Northridge, CA 91324-4663 | 2005-10-11 |
| 1922514223 | Seeta Stacie Nanoo | Nurse Practitioner | 18546 Roscoe Blvd, Northridge, CA 91324-4663 | 2017-12-21 |
| 1598164659 | Alain Karaguezian Md PC | Family Medicine | 18546 Roscoe Blvd, Suite 304, Northridge, CA 91324-4663 | 2014-08-14 |
| 1477890291 | Innovative Dialysis Center of Northridge, LLC | Clinic/Center | 18546 Roscoe Blvd, Suite 108, Northridge, CA 91324-4663 | 2013-01-14 |
| 1285946046 | Minas Kochumian, Md, A Medical Corporation | Non-Pharmacy Dispensing Site | 18546 Roscoe Blvd, 312, Northridge, CA 91324-4663 | 2010-07-09 |
| 1700035193 | Stefanie A Proia | Nurse Practitioner | 18546 Roscoe Blvd, Suite 211, Northridge, CA 91324-4663 | 2008-09-10 |
| 1528226602 | Sherry Ann L. Sanvictores | Nurse Practitioner | 18546 Roscoe Blvd, Suite 306, Northridge, CA 91324-4663 | 2008-05-27 |
| 1811023708 | Jirair Konialian Medical Corporation | Clinic/Center | 18546 Roscoe Blvd, Suite 220, Northridge, CA 91324-5455 | 2007-02-26 |
| 1295884088 | Ehab S Yacoub | Psychiatry & Neurology | 18546 Roscoe Blvd, Suite 210, Northridge, CA 91324-4663 | 2007-01-09 |
| 1184785297 | Michael W. Barsom, Md, Amc | Psychiatry & Neurology | 18546 Roscoe Blvd, Suite 210, Northridge, CA 91324-4663 | 2006-12-12 |
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| 1649803461 | Endeavor Recovery LLC | Clinic/Center | 8537 Yolanda Ave, Northridge, CA 91324 | 2020-02-20 |
| 1780227769 | Drs Concepts, Incorporated | Clinic/Center | 9335 Reseda Blvd. Suite 102, Northridge, CA 91324 | 2019-10-23 |
| 1023674421 | Expo Diagnostics, Inc. | Clinic/Center | 8619 Receda Blvd., Northridge, CA 91324 | 2019-05-13 |
| 1235601444 | Grace Peprah | Marriage & Family Therapist | 19037 Community Street, Northridge, CA 91324 | 2018-12-28 |
| 1336635531 | Kristel Fortuny Bushner | Specialist/Technologist | 9555 Reseda Blvd, 309, Northridge, CA 91324 | 2018-07-11 |
| 1710474358 | Rara Enterprises Inc | Pharmacy | 19331 Business Center Dr., Ste. 100, Northridge, CA 91324 | 2018-04-19 |
| 1205343670 | Mariana Nicol Valdez Castro | Behavior Technician | 9335 Reseda Blvd # 101, Northridge, CA 91324 | 2018-01-05 |
| 1033655220 | Benyaminy and Kashani Dds,inc. | Clinic/Center | 8954 Reseda Blvd #100, Northridge, CA 91324 | 2017-01-11 |
| 1366809915 | Tia Brisco | Counselor | 9700 Reseda Blvd Ste 208, Northridge, CA 91324 | 2016-01-26 |
| 1053780189 | Saloni Kadakia | Student in an Organized Health Care Education/Training Program | Ucla Olive View, 14445 Olive View Dr, Sylmar, Ca 91342, CA 91324 | 2015-09-18 |
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| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245739820 | Northridge Vascular Center A Professional Medical Corporation | Surgery | 19331 Business Center Dr Ste 102, Northridge, CA 91324-3533 | 2018-02-08 |
| 1811064728 | Richard A Guest | Surgery | 18250 Roscoe Blvd, Suite 335, Northridge, CA 91325-4216 | 2006-11-29 |
| 1528050960 | Eswar Appa Nyamathi | Surgery | 17075 Devonshire St, Ste 106, Northridge, CA 91325-1600 | 2005-08-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881213817 | Robert Morton Carroll X | Surgery | 2241 Century Hl, Los Angeles, CA 90067-3506 | 2020-04-09 |
| 1992341895 | Surgicalist of Ca PC | Surgery | 3300 E South St Ste 301a, Lakewood, CA 90805-4549 | 2019-11-26 |
| 1528600558 | Kevin M Casey Md Apmc | Surgery | 1919 State St # 204-206, Santa Barbara, CA 93101-2430 | 2019-10-10 |
| 1487117594 | John Nastasi | Surgery | 100 W Valencia Mesa Dr # 211, Fullerton, CA 92835-3768 | 2019-04-08 |
| 1225508385 | Jay Labourene | Surgery | 1550 G Tiburon Blvd, Tiburon, CA 94920-2531 | 2018-12-03 |
| 1467922120 | Paul Bressman Md Inc | Surgery | 1493 S Crest Dr, Los Angeles, CA 90035-3339 | 2018-11-26 |
| 1437638517 | Thousand Oaks Vein Clinic PC | Surgery | 225 N Moorpark Rd Ste C, Thousand Oaks, CA 91360-4320 | 2018-08-09 |
| 1881186377 | Lavs Access Center Inc. | Surgery | 620 W Beverly Blvd Ste B, Montebello, CA 90640-3624 | 2018-05-31 |
| 1841789328 | Sunil Rayan, M.d., Inc. | Surgery | 320 Santa Fe Dr Ste 212, Encinitas, CA 92024-5139 | 2018-05-09 |
| 1740788744 | Adventist Health Physicians Network | Surgery | 414 G St Ste 112, Marysville, CA 95901-5669 | 2018-01-25 |
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| City | NORTHRIDGE |
| Zip Code | 91324 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.