1871146761 NPI number — SHIFA DIALYSIS CENTER HUMBOLDT PARK, LLC

Table of content: SHERIN TAHMASBI FNP (NPI 1265855951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871146761 NPI number — SHIFA DIALYSIS CENTER HUMBOLDT PARK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHIFA DIALYSIS CENTER HUMBOLDT PARK, LLC
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:
1871146761
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1658 N MILWAUKEE AVE, SUITE 4
Provider Second Line Business Mailing Address:
BOX# 314
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60647-6905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-232-2300
Provider Business Mailing Address Fax Number:
773-232-2301

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1044 N MOZART ST STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60622-2789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-772-9400
Provider Business Practice Location Address Fax Number:
773-772-3935
Provider Enumeration Date:
07/19/2019

Additional Information

Authorized Official

Authorized Official Last Name:
SHAH-KHAN
Authorized Official First Name:
FARHEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
773-232-2300

Provider Taxonomy Codes

  • Taxonomy code: 261QE0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2026 www.npivalidator.com