Healthcare Provider Details

I. General information

NPI: 1831730183
Provider Name (Legal Business Name): KIDNEY ASSOCIATES OF THE TRISTATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2019
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6909 BURLINGTON PIKE STE B
FLORENCE KY
41042-1618
US

IV. Provider business mailing address

PO BOX 6018
FLORENCE KY
41022-6018
US

V. Phone/Fax

Practice location:
  • Phone: 859-912-7716
  • Fax:
Mailing address:
  • Phone: 502-662-6094
  • Fax: 859-495-0046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AI TRAN
Title or Position: DIRECTOR
Credential: MD
Phone: 859-806-4876