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General NPI Number Information
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NPI Number | 1447338710
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Entity Type | Organization
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Legal Business Name | KINGMAN KIDNEY CLINIC INC.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 06/03/2014
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Provider Practice Location Address
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Address Line | 4055 STOCKTON HILL RD STE 15
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City | KINGMAN
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State | AZ
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Zip | 86409-2469
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Country | US
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Telephone | 928-692-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 10917 72ND RD STE 6R
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City | FOREST HILLS
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State | NY
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Zip | 11375-5336
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Country | US
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Telephone | 718-268-6906
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | RAMESH SARVA
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Credential |
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Telephone | 718-268-6906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number | OTC2527
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License Number State | AZ
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