Basic Information
| Provider Information | |||||||||
| NPI: | 1649601352 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTH BAY NEPHROLOGY ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2360 MCKEE RD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951161618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087297128 | ||||||||
| FaxNumber: | 4087294125 | ||||||||
| Practice Location | |||||||||
| Address1: | 2360 MCKEE RD | ||||||||
| Address2: | SUITE 10 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951161618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087297128 | ||||||||
| FaxNumber: | 4087294125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2013 | ||||||||
| LastUpdateDate: | 06/20/2018 | ||||||||
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| AuthorizedOfficialLastName: | KU | ||||||||
| AuthorizedOfficialFirstName: | WEN-TSANG | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4087297128 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | A43854 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.