Provider Demographics
NPI:1114654274
Name:AZ KIDNEY DR LLC
Entity Type:Organization
Organization Name:AZ KIDNEY DR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KUSSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSAMKARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-741-5504
Mailing Address - Street 1:436 E SOUTHERN AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5216
Mailing Address - Country:US
Mailing Address - Phone:480-336-2039
Mailing Address - Fax:602-207-8899
Practice Address - Street 1:436 E SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282-5216
Practice Address - Country:US
Practice Address - Phone:480-336-2039
Practice Address - Fax:602-207-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty