Provider Demographics
NPI:1487064747
Name:GOLDEN EMPIRE CARDIOLOGY
Entity type:Organization
Organization Name:GOLDEN EMPIRE CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-321-3161
Mailing Address - Street 1:3838 SAN DIMAS ST STE B201
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1496
Mailing Address - Country:US
Mailing Address - Phone:661-321-3161
Mailing Address - Fax:661-321-3166
Practice Address - Street 1:3838 SAN DIMAS ST STE B201
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1496
Practice Address - Country:US
Practice Address - Phone:661-321-3161
Practice Address - Fax:661-321-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGROO83200Medicaid
CF274YMedicare PIN