Basic Information
| Provider Information | |||||||||
| NPI: | 1982631222 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEPHROLOGY ASSOCIATES OF UPLAND AND POMONA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1869 | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917851869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099815882 | ||||||||
| FaxNumber: | 9093850379 | ||||||||
| Practice Location | |||||||||
| Address1: | 1317 W FOOTHILL BLVD STE 148 | ||||||||
| Address2: | |||||||||
| City: | UPLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917863675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9099815882 | ||||||||
| FaxNumber: | 9093732828 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | HENG | ||||||||
| AuthorizedOfficialFirstName: | MARGARET | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9099815882 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 01/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | GR0025730 | 05 | CA | MEDICAID | GR0025733 | 05 | CA | MEDICAID | GR0025734 | 05 | CA | MEDICAID | GR0025731 | 05 | CA | MEDICAID | GR0025732 | 05 | CA | MEDICAID |