Provider Demographics
NPI:1760497457
Name:CALIFORNIA KIDNEY SPECIALISTS
Entity Type:Organization
Organization Name:CALIFORNIA KIDNEY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROYA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAHMASSEBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-542-2770
Mailing Address - Street 1:1335 W CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3537
Mailing Address - Country:US
Mailing Address - Phone:909-542-2770
Mailing Address - Fax:909-394-1800
Practice Address - Street 1:1335 W CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3537
Practice Address - Country:US
Practice Address - Phone:909-542-2770
Practice Address - Fax:909-394-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty