Provider Demographics
NPI:1861901191
Name:NORTHRIDGE KIDNEY CARE CENTER LLC
Entity type:Organization
Organization Name:NORTHRIDGE KIDNEY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ASSOMULL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-366-4626
Mailing Address - Street 1:4000 COVER ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-1790
Mailing Address - Country:US
Mailing Address - Phone:562-421-2690
Mailing Address - Fax:562-421-2060
Practice Address - Street 1:19333 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-3528
Practice Address - Country:US
Practice Address - Phone:818-709-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-29
Last Update Date:2017-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment