Provider Demographics
NPI:1265725659
Name:THE KIDNEY CENTER OF CHARLESTON LLC
Entity type:Organization
Organization Name:THE KIDNEY CENTER OF CHARLESTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:BUENOR
Authorized Official - Last Name:AYIKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-532-4185
Mailing Address - Street 1:191 SWEET GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7838
Mailing Address - Country:US
Mailing Address - Phone:843-532-4185
Mailing Address - Fax:866-342-9587
Practice Address - Street 1:1481 TOBIAS GADSON BLVD
Practice Address - Street 2:SUITE 2A
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-4794
Practice Address - Country:US
Practice Address - Phone:843-270-3853
Practice Address - Fax:866-342-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty