Provider Demographics
NPI:1922183045
Name:KIDNEY INSTITUTE AT EMC LLC
Entity Type:Organization
Organization Name:KIDNEY INSTITUTE AT EMC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMBUR
Authorized Official - Middle Name:ERIAH
Authorized Official - Last Name:CHANDRASHEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-837-9696
Mailing Address - Street 1:39000 BOB HOPE DR
Mailing Address - Street 2:STE. P-103
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-837-9696
Mailing Address - Fax:760-837-9984
Practice Address - Street 1:39000 BOB HOPE DR
Practice Address - Street 2:STE. P-103
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-837-9696
Practice Address - Fax:760-837-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC02832FMedicaid
CACDC02832FMedicaid