Provider Demographics
NPI:1679903231
Name:PACIFIC KIDNEY & HYPERTENSION, LLC
Entity Type:Organization
Organization Name:PACIFIC KIDNEY & HYPERTENSION, LLC
Other - Org Name:OREGON KIDNEY & HYPERTENSION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GIULLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-397-0197
Mailing Address - Street 1:1820 E RAY RD STE B201
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-8720
Mailing Address - Country:US
Mailing Address - Phone:855-397-0197
Mailing Address - Fax:800-272-6512
Practice Address - Street 1:232 NE NORTON LN
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-8470
Practice Address - Country:US
Practice Address - Phone:503-434-1159
Practice Address - Fax:503-434-1190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500689878Medicaid
WA2079319Medicaid