1184660169 NPI number — KIDNEY CENTER OF VAN NUYS, INC

Table of content: (NPI 1184660169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184660169 NPI number — KIDNEY CENTER OF VAN NUYS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDNEY CENTER OF VAN NUYS, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184660169
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 251549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75025-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-736-2700
Provider Business Mailing Address Fax Number:
214-736-2701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14624 SHERMAN WAY
Provider Second Line Business Practice Location Address:
SUITE # 106
Provider Business Practice Location Address City Name:
VAN NUYS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91405-2241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-994-2333
Provider Business Practice Location Address Fax Number:
805-433-7655
Provider Enumeration Date:
06/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WEINBERG
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
214-736-2700

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X , with the licence number:  930000269 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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