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General NPI Number Information
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NPI Number | 1780007435
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Entity Type | Organization
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Legal Business Name | KIDNEY CENTER OF WALKER COUNTY LLC
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Dates
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Enumeration Date | 01/31/2014
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 102 MEDICAL PARK LN SUITE A
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City | HUNTSVILLE
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State | TX
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Zip | 77340-4975
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Country | US
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Telephone | 936-294-0971
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Fax | 936-294-0977
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Provider Business Mailing Address
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Address Line | 102 MEDICAL PARK LN SUITE A
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City | HUNTSVILLE
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State | TX
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Zip | 77340-4975
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Country | US
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Telephone | 936-294-0971
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Fax | 936-294-0977
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Authorized Official
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Title or Position | OWNER
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Name | MR. DAVE S KHURANA
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Credential | MD
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Telephone | 936-294-0971
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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 | M1828
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License Number State | TX
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