1649601352 NPI number — SOUTH BAY NEPHROLOGY ASSOCIATES, PC

Table of content: MS. KAREN KATRINA PEARSON LPC (NPI 1699070698)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649601352 NPI number — SOUTH BAY NEPHROLOGY ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH BAY NEPHROLOGY ASSOCIATES, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649601352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2360 MCKEE RD
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
SAN JOSE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95116-1618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-729-7128
Provider Business Mailing Address Fax Number:
408-729-4125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2360 MCKEE RD
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95116-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-729-7128
Provider Business Practice Location Address Fax Number:
408-729-4125
Provider Enumeration Date:
12/05/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KU
Authorized Official First Name:
WEN-TSANG
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
408-729-7128

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  A43854 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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