Healthcare Provider Details

I. General information

NPI: 1821304403
Provider Name (Legal Business Name): PEDIATRIC KIDNEY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2010
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5309 AURORA WAY
BAKERSFIELD CA
93306-7808
US

IV. Provider business mailing address

PO BOX 60238
BAKERSFIELD CA
93386-0238
US

V. Phone/Fax

Practice location:
  • Phone: 310-309-0403
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberA93348
License Number StateCA

VIII. Authorized Official

Name: DR. NIMISHA AMIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-309-0403