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General NPI Number Information
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NPI Number | 1013475326
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Entity Type | Organization
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Legal Business Name | KIDNEY GUARDIAN
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Dates
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Enumeration Date | 03/05/2019
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 436 E SOUTHERN AVE
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City | TEMPE
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State | AZ
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Zip | 85282-5216
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Country | US
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Telephone | 480-297-7361
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Fax | 602-207-8899
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Provider Business Mailing Address
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Address Line | PO BOX 10741
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City | TEMPE
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State | AZ
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Zip | 85284-0013
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Country | US
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Telephone | 602-741-5504
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | MHD KUSSAY SAMKARI
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Credential | MD
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Telephone | 480-895-8734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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