MEDICARE: KIDNEY SPECIALIST INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RN0300X	Nephrology Physician	C-52769	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1669422812	OTHER	CA	NPI

General Provider Information

NPI Number	:	1356539423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY SPECIALIST INC.

Provider Business Mailing Address
First Line	:	451 E ALMOND AVE STE 101
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-5562
Country	:	US
Telephone Number	:	559-661-1965
Fax Number	:	559-661-1952

Provider Business Practice Location Address
First Line	:	451 E ALMOND AVE STE 101
Second Line	:
City	:	MADERA
State	:	CA
Zip	:	93637-5562
Country	:	US
Telephone Number	:	559-661-1965
Fax Number	:	559-661-1952

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SHEIKH MOHAMMAD MASOOD
Credential	:	M.D
Telephone Number	:	559-661-1965

Provider Enumeration Date	:	10/14/2007
Last Update Date	:	06/03/2022

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Directions to “KIDNEY SPECIALIST INC. ” Practice Location

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