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General NPI Number Information
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NPI Number | 1194242313
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Entity Type | Organization
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Legal Business Name | CALIFORNIA KIDNEY DISEASE ASSOCIATES
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Dates
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Enumeration Date | 08/28/2017
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Last Update Date | 06/13/2023
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Provider Practice Location Address
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Address Line | 1736 PROFESSIONAL DR
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City | SACRAMENTO
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State | CA
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Zip | 95825-2105
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Country | US
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Telephone | 916-500-4706
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Fax | 916-200-4999
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Provider Business Mailing Address
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Address Line | PO BOX 980934
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City | W SACRAMENTO
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State | CA
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Zip | 95798-0934
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Country | US
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Telephone | 916-500-4706
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Fax | 916-200-4999
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Authorized Official
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Title or Position | OWNER
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Name | DR. ABDUL NURISTANI
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Credential | MD
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Telephone | 916-500-4706
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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 | A121191
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | A121191
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License Number State | CA
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