Basic Information
| Provider Information | |||||||||
| NPI: | 1063702405 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAU | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 LANSING ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211983 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155670390 | ||||||||
| FaxNumber: | 3155670333 | ||||||||
| Practice Location | |||||||||
| Address1: | 77 NELSON STREET, SUITE 240 | ||||||||
| Address2: | AMMS NEPHROLOGY | ||||||||
| City: | AUBURN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130211302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3155670390 | ||||||||
| FaxNumber: | 3157028393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2011 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 288997 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 288997 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 04778272 | 05 | NY | MEDICAID |