Provider Demographics
NPI:1598172223
Name:VICTORY KIDNEY CLINIC P.A.
Entity Type:Organization
Organization Name:VICTORY KIDNEY CLINIC P.A.
Other - Org Name:VICTORY KIDNEY CLINIC P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BICHENG
Authorized Official - Middle Name:
Authorized Official - Last Name:NAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-796-1390
Mailing Address - Street 1:902 HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78040-8015
Mailing Address - Country:US
Mailing Address - Phone:956-796-1390
Mailing Address - Fax:956-796-9495
Practice Address - Street 1:902 HOUSTON ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-8015
Practice Address - Country:US
Practice Address - Phone:956-796-1390
Practice Address - Fax:956-796-9495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1011207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty