Provider Demographics
NPI:1770609711
Name:ANTELOPE VALLEY KIDNEY INSTITUTE, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ANTELOPE VALLEY KIDNEY INSTITUTE, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNKU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-945-7755
Mailing Address - Street 1:43932 15TH ST W
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5207
Mailing Address - Country:US
Mailing Address - Phone:661-945-7755
Mailing Address - Fax:661-945-7786
Practice Address - Street 1:43932 15TH ST REET WEST
Practice Address - Street 2:SUITE 103
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5207
Practice Address - Country:US
Practice Address - Phone:661-945-7755
Practice Address - Fax:661-945-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2016-09-23
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
CA552593Medicare Oscar/Certification