Healthcare Provider Details

I. General information

NPI: 1780547323
Provider Name (Legal Business Name): KJ RENAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

B1 CALLE 1 ALTOS FARMACIA MEDINA #2 VILLAS DE LOIZA
CANOVANAS PR
00729-4116
US

IV. Provider business mailing address

A8 VIA HORIZONTE
SAN JUAN PR
00924-4461
US

V. Phone/Fax

Practice location:
  • Phone: 787-886-3254
  • Fax: 787-957-1555
Mailing address:
  • Phone:
  • Fax: 787-957-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRYSTAHL Z ANDUJAR RIVERA
Title or Position: CEO
Credential: MD
Phone: 787-956-8918