Provider Demographics
NPI:1528655362
Name:KIDNEY SOLUTIONS INC
Entity type:Organization
Organization Name:KIDNEY SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN-CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSILA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-863-4776
Mailing Address - Street 1:1005 NORTHGATE DR # 121
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2500
Mailing Address - Country:US
Mailing Address - Phone:858-863-4776
Mailing Address - Fax:
Practice Address - Street 1:1005 NORTHGATE DR # 121
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2500
Practice Address - Country:US
Practice Address - Phone:858-863-4776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-28
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty