MEDICARE: KJ RENAL LLC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1780547323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KJ RENAL LLC

Provider Business Mailing Address
First Line	:	A8 VIA HORIZONTE
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00924-4461
Country	:	US
Telephone Number	:
Fax Number	:	787-957-1555

Provider Business Practice Location Address
First Line	:	B1 CALLE 1 ALTOS FARMACIA MEDINA #2
Second Line	:	VILLAS DE LOIZA
City	:	CANOVANAS
State	:	PR
Zip	:	00729-4116
Country	:	US
Telephone Number	:	787-886-3254
Fax Number	:	787-957-1555

Authorized Official
Title or Position	:	CEO
Name	:	KRYSTAHL Z ANDUJAR RIVERA
Credential	:	MD
Telephone Number	:	787-956-8918

Provider Enumeration Date	:	12/09/2025
Last Update Date	:	12/09/2025

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