MEDICARE: KIDNEY CONSULTANTS MEDICAL GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427120682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDNEY CONSULTANTS MEDICAL GROUP, INC

Provider Business Mailing Address
First Line	:	11550 INDIAN HILLS RD
Second Line	:	SUITE 371
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-1252
Country	:	US
Telephone Number	:	818-365-1194
Fax Number	:	818-898-3835

Provider Business Practice Location Address
First Line	:	11550 INDIAN HILLS RD
Second Line	:	SUITE 371
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-1252
Country	:	US
Telephone Number	:	818-365-1194
Fax Number	:	818-898-3835

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. OMARAN ABDEEN
Credential	:	M.D
Telephone Number	:	818-365-1194

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	11/06/2018

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