Healthcare Provider Details

I. General information

NPI: 1235056680
Provider Name (Legal Business Name): RENEE DUA MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8349 RESEDA BLVD STE G
NORTHRIDGE CA
91324-5914
US

IV. Provider business mailing address

8349 RESEDA BLVD STE G
NORTHRIDGE CA
91324-5914
US

V. Phone/Fax

Practice location:
  • Phone: 323-682-9246
  • Fax:
Mailing address:
  • Phone: 323-682-9246
  • 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: DR. RENEE DUA
Title or Position: CEO
Credential: MD
Phone: 323-682-9246