Provider Demographics
NPI:1447138227
Name:KIDNEY DISEASE CONSULTING GROUP
Entity type:Organization
Organization Name:KIDNEY DISEASE CONSULTING GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVET
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKISSIAN PEKACHEKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-590-5940
Mailing Address - Street 1:501 W GLENOAKS BLVD # 809
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-2896
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1505 WILSON TER
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4071
Practice Address - Country:US
Practice Address - Phone:818-590-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center