Healthcare Provider Details

I. General information

NPI: 1881560530
Provider Name (Legal Business Name): NVIN PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12827 HARBOR BLVD STE G1
GARDEN GROVE CA
92840-5839
US

IV. Provider business mailing address

2868 SAINT DIZIER DR
HENDERSON NV
89044-0376
US

V. Phone/Fax

Practice location:
  • Phone: 714-534-1680
  • Fax:
Mailing address:
  • Phone: 702-460-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: BASKER PERIYASAMY
Title or Position: PRESIDENT
Credential: MD
Phone: 702-460-8119