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MODESTO KIDNEY MEDICAL GROUP
NPI 1306848569
Internal Medicine - Nephrology in Modesto, CA

Active since June 01, 2005CLIA 05D0610308 · Microscopy
305 E GRANGER AVE, STE 202, MODESTO, CA 95350(209) 526-1606(209) 526-1677 Get Directions Write a Review

NPPES record last updated: March 29, 2013. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Modesto Kidney Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MODESTO KIDNEY MEDICAL GROUP (NPI 1306848569), doing business as Itsara And Liu Md's, is a healthcare organization registered as a nephrology in Modesto, California and active in the NPI registry since June 2005. The organization holds a CLIA Microscopy certificate valid through August 31, 2026 and lists Lori D Meischke, Billing Manager, as its authorized official.

NPPES Registry Identity

NPI1306848569
Entity TypeOrganization
Primary Taxonomy207RN0300X
Legal Business NameMODESTO KIDNEY MEDICAL GROUP
Location Address305 E GRANGER AVE, STE 202Modesto, CA 95350-4344
Mailing Address305 E Granger Ave, Suite 202Modesto, CA 95350-4345 · (209) 526-1606 · Fax (209) 526-1677
Phone(209) 526-1606
Fax(209) 526-1677
Organization SubpartNo
Authorized OfficialLori D MeischkeBilling Manager · (541) 706-9073
Enumeration DateJune 1, 2005
Last NPPES UpdateMarch 29, 2013
✔ NPI 1306848569 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · NephrologyAllopathic & Osteopathic Physicians
Taxonomy Code207RN0300X
License✔ Licensed in CA · 01031187 02
Definition
An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation.
305 E GRANGER AVE, Modesto, CA 95350
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Other Names 1

Former Legal Business NameItsara And Liu Md's

Other Identifiers 2

Medicare PINYYY49963YCA
MedicaidGR0026660CA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D0610308

Modesto Kidney Medical Group · Modesto, CA
Active · expires Aug 31, 2026
CLIA Number05D0610308
Laboratory TypePhysician Office
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorChang Joo
Laboratory Phone(209) 526-1606
Laboratory LocationModesto Kidney Medical Group305 E Granger Avenue, Suite 202, Modesto, CA 95350
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MODESTO KIDNEY CENTER, INC.
Clinic/Center (End-Stage Renal Disease (ESRD) Treatment)
305 E GRANGER AVE
MODESTO, CA 95350
Stanislaus County (209) 574-6800
KENNETH K LIU MD
Internal Medicine (Nephrology)
305 E GRANGER AVE, STE 202
MODESTO, CA 95350
Stanislaus County (209) 526-1606
CHANG S JOO MD
Internal Medicine (Nephrology)
305 E GRANGER AVE, STE 202
MODESTO, CA 95350
Stanislaus County (209) 526-1606
KRIENGSAK ITSARA MD
Internal Medicine (Nephrology)
305 E GRANGER AVE, STE 202
MODESTO, CA 95350
Stanislaus County (206) 526-1606
TONG SUN MD
Internal Medicine (Nephrology)
305 E GRANGER AVE, STE 202
MODESTO, CA 95350
Stanislaus County (209) 526-1606

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Modesto Kidney Medical Group's NPI number?

The NPI number for Modesto Kidney Medical Group is 1306848569. It was assigned to this organization in the NPPES registry on June 1, 2005. The provider was formerly known as Itsara And Liu Md's.

Where is Modesto Kidney Medical Group located?

Modesto Kidney Medical Group is located at 305 E Granger Ave Ste 202, Modesto, CA 95350. The listed phone number is (209) 526-1606.

What is Modesto Kidney Medical Group's specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Nephrology, with taxonomy code 207RN0300X.

Does Modesto Kidney Medical Group hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 05D0610308) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Modesto Kidney Medical Group was last updated on March 29, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.