Healthcare Provider Details

I. General information

NPI: 1396217162
Provider Name (Legal Business Name): HOUSTON KIDNEY SPECIALISTS CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2018
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13656 BRETON RIDGE ST STE A-H
HOUSTON TX
77070-6081
US

IV. Provider business mailing address

2149 E WARNER RD STE 102
TEMPE AZ
85284-3495
US

V. Phone/Fax

Practice location:
  • Phone: 281-429-8780
  • Fax: 281-763-7930
Mailing address:
  • Phone: 480-393-0309
  • Fax: 480-610-6189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GHAYYATH SULTAN
Title or Position: PRESIDENT
Credential: MD
Phone: 216-702-4535