=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821163304
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIDNEY CARE OF ACADIANA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 224 SAINT LANDRY ST SUITE 1-C
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70506-3549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-233-3538
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 224 SAINT LANDRY ST SUITE 1-C
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70506-3549
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-233-3538
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. MASOUD YAZDI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 337-233-3538
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | 261Q00000X
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------