VALLEY KIDNEY CLINIC INC (NPI# 1023247079) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023247079 |
| Entity Type | Organization |
| Organization Name | VALLEY KIDNEY CLINIC INC |
| Other Organization Name | VALLEY KIDNEY CLINIC INC |
| Practice Address |
1801 E March Ln Suite B265 Stockton CA 95210-6629 |
| Practice Telephone | 2095461868 |
| Practice Fax Number | 2094616505 |
| Mailing Telephone | 2095461868 |
| Mailing Fax Number | 2094616505 |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2015-06-19 |
| Authorized Official Name | DR. MALLAREDDY MADDULA (MD) |
| Authorized Official Telephone | 2095461868 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | A108120 | CA | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICARE | CB972A | 01 |
| CA | STATE LICENSE | A108120 | 01 |
| Other Name | Type Code |
|---|---|
| Valley Kidney Clinic Inc | Doing Business As Name - Organization |
| Street Address |
1801 E MARCH LN SUITE B265 |
| City | STOCKTON |
| State | CA |
| Zip Code | 95210-6629 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043215270 | Ronald A Kass | Internal Medicine | 1801 E March Ln, Suite C300, Stockton, CA 95210-6629 | 2005-06-15 |
| 1700327525 | Lakshmi Kulkarni | Pharmacist | 1801 E March Ln, Suite B280, Stockton, CA 95210-6629 | 2017-03-13 |
| 1811343734 | Josebelo D. Chong, M.d. Inc. | Internal Medicine | 1801 E March Ln, Suite C300, Stockton, CA 95210-6629 | 2016-05-10 |
| 1093113631 | Vijaysri Nannapaneni | Pharmacist | 1801 E March Ln, Suite B280, Stockton, CA 95210-6629 | 2014-12-15 |
| 1790107829 | Barry K Wilson Md Inc | Anesthesiology | 1801 E March Ln, Suite 360, Stockton, CA 95210-6629 | 2014-01-08 |
| 1396007100 | Jennifer Williams | Internal Medicine | 1801 E March Ln, Stockton, CA 95210 | 2012-06-08 |
| 1376815605 | Zeiter Eye Medical Group Inc Oculafacial Plastic and Reconstructive Su | Surgery | 1801 E March Ln, Suite A160, Stockton, CA 95210-6629 | 2012-02-02 |
| 1790080182 | James Lester Avery | Physician Assistant | 1801 E March Ln, D-460, Stockton, CA 95210-6629 | 2011-01-17 |
| 1477884161 | Kusum Lata | Internal Medicine | 1801 E March Ln, #a-170, Stockton, CA 95210-6629 | 2010-01-20 |
| 1316176035 | Sanjeev K. Goswami, Md, Inc. | Internal Medicine | 1801 E March Ln, C 300, Stockton, CA 95210-6629 | 2009-07-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063021970 | Leslie Jazmin Marin | Student in an Organized Health Care Education/Training Program | 7109 Danny Dr, Stockton, Stockton, CA 95210 | 2020-07-27 |
| 1043866692 | Alexis Thomasson | Behavior Technician | 7109 Danny Drive, Stockton, CA 95210 | 2019-08-09 |
| 1821651324 | Maria Guadalupe Toledo | Lactation Consultant, Non-RN | 7912 Hammer Lane, Stockton, CA 95210 | 2019-04-19 |
| 1508226440 | Active Life Adult Day Care, Inc. | Clinic/Center | 7209 Tam O'shanter Dr., Stockton, CA 95210 | 2016-03-04 |
| 1548631260 | Rachel Standley | Substance Abuse Rehabilitation Facility | 8017 El Cajon St, Stockton, CA 95210 | 2015-10-08 |
| 1225435308 | Active Life Medical Produtcs Inc | Durable Medical Equipment & Medical Supplies | 611 W Grider Way, Stockton, CA 95210 | 2014-12-04 |
| 1942633318 | Kimberly Ruiz Dizon | Physician Assistant | 1530 E Hammer Ln, Stockton, CA 95210 | 2013-08-20 |
| 1285920983 | Supplemental Health Care | Preferred Provider Organization | 8425 Kiltie Wy, Stockton, CA 95210 | 2011-06-22 |
| 1770807901 | Stockton Medical Weight Loss Center Inc | Internal Medicine | 1801 E. March Lane, Suite 400d, Stockton, CA 95210 | 2010-03-17 |
| 1699911412 | Pratap Krishna Anne | Pharmacist | 1801 E.march Ln, Suite:b280, Bjrx, Stockton, CA 95210 | 2008-12-29 |
| Find all providers in zip 95210 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063943223 | Medcore Hp | Specialist | 2701 E Hammer Ln, Suite 103, Stockton, CA 95210-4245 | 2017-03-21 |
| 1730577917 | Kathryn Debaca | Specialist | 1424 Morrison Ave, Stockton, CA 95205-3538 | 2014-12-22 |
| 1538575428 | Sarah R.a. Pavis | Specialist | 7489 Shoreline Dr, Stockton, CA 95219-4587 | 2014-07-11 |
| 1033451976 | Sheila E Buchbinder | Specialist | 205 Sandy Ridge Mount Airy Rd, Stockton, NJ 08559-1904 | 2013-03-18 |
| 1861751273 | Thomas Tao-yuan Chen | Specialist | 2220 Broadridge Way, Stockton, CA 95209-1247 | 2012-05-07 |
| 1801107438 | Treedeen Tether | Specialist | 3591 Quail Lakes Dr, Unit 136, Stockton, CA 95207-5234 | 2010-06-29 |
| 1578739173 | Sue Yi Shia | Specialist | 1422 William Moss Blvd, Stockton, CA 95206-5666 | 2008-05-02 |
| 1801095419 | Kristine Joanne Andres | Specialist | 1304 Sagewood Ct, Stockton, CA 95210-3527 | 2007-07-13 |
| 1689880064 | Prabhjit S. Purewal, Md, Inc. | Specialist | 4722 Quail Lakes Dr Ste A, Stockton, CA 95207-5244 | 2007-05-15 |
| 1720208481 | Ronald C. Allison M.d. Inc. | Specialist | 415 E Harding Way Ste H, Stockton, CA 95204-6118 | 2007-04-26 |
| Find all providers in STOCKTON | ||||
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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.