Provider Demographics
NPI:1124285465
Name:KARNAVY MEDICAL GROUP, INC
Entity type:Organization
Organization Name:KARNAVY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICHIEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:KARNAVY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-982-8976
Mailing Address - Street 1:300 E 7TH ST
Mailing Address - Street 2:STE. 2E
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6778
Mailing Address - Country:US
Mailing Address - Phone:909-982-8976
Mailing Address - Fax:909-920-3176
Practice Address - Street 1:300 E 7TH ST
Practice Address - Street 2:STE. 2E
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6778
Practice Address - Country:US
Practice Address - Phone:909-982-8976
Practice Address - Fax:909-920-3176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34414207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27475Medicare UPIN