Provider Demographics
NPI:1821163304
Name:KIDNEY CARE OF ACADIANA
Entity Type:Organization
Organization Name:KIDNEY CARE OF ACADIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-233-3538
Mailing Address - Street 1:224 SAINT LANDRY ST
Mailing Address - Street 2:SUITE 1-C
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-3549
Mailing Address - Country:US
Mailing Address - Phone:337-233-3538
Mailing Address - Fax:
Practice Address - Street 1:224 SAINT LANDRY ST
Practice Address - Street 2:SUITE 1-C
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-3549
Practice Address - Country:US
Practice Address - Phone:337-233-3538
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA261Q00000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1432440Medicaid
LA=========OtherTAX ID
LA=========OtherTAX ID
LAB63743Medicare UPIN