Provider Demographics
NPI:1952536278
Name:EAST VALLEY KIDNEY CENTER, INC.
Entity Type:Organization
Organization Name:EAST VALLEY KIDNEY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMEESH
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:GARG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-626-2020
Mailing Address - Street 1:3317 S HIGLEY RD
Mailing Address - Street 2:SUITE 114-262
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297-5436
Mailing Address - Country:US
Mailing Address - Phone:480-626-2020
Mailing Address - Fax:480-626-2022
Practice Address - Street 1:5432 E SOUTHERN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-2772
Practice Address - Country:US
Practice Address - Phone:480-626-2020
Practice Address - Fax:480-626-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-17
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29907207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty