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General NPI Number Information
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NPI Number | 1164895181
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Entity Type | Organization
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Legal Business Name | KIDNEY CARE NEPHROLOGY, INC.
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Dates
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Enumeration Date | 11/13/2015
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 400 N PEPPER AVE
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City | COLTON
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State | CA
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Zip | 92324-1801
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Country | US
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Telephone | 312-402-1502
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Fax | 909-363-7447
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Provider Business Mailing Address
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Address Line | 6509 E PASEO DIEGO
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City | ANAHEIM
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State | CA
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Zip | 92807-5011
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Country | US
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Telephone | 312-402-1502
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | POOJA MAHAJAN BADLANI
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Credential | MD
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Telephone | 312-402-1502
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A117250
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License Number State | CA
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