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General NPI Number Information
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NPI Number | 1326289927
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Entity Type | Organization
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Legal Business Name | BRYAN KIDNEY CENTER PLLC
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 2110 E VILLA MARIA RD
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City | BRYAN
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State | TX
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Zip | 77802-2542
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Country | US
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Telephone | 979-412-2623
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Fax | 979-822-3333
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Provider Business Mailing Address
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Address Line | PO BOX 11056
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City | COLLEGE STATION
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State | TX
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Zip | 77842-1056
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Country | US
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Telephone | 979-822-5555
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Fax | 979-822-3333
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. ASAD KHAN
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Credential | M.D.
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Telephone | 979-412-2623
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | N2142
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License Number State | TX
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