Provider Demographics
NPI:1366527483
Name:KIDNEY INSTITUTE OF THE DESERT LLC
Entity type:Organization
Organization Name:KIDNEY INSTITUTE OF THE DESERT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMBUR
Authorized Official - Middle Name:ERIAH
Authorized Official - Last Name:CHANDRASHEKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-347-8181
Mailing Address - Street 1:81715 DR CARREON BLVD
Mailing Address - Street 2:STE B2
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201
Mailing Address - Country:US
Mailing Address - Phone:760-347-8181
Mailing Address - Fax:760-775-2899
Practice Address - Street 1:81715 DR CARREON BLVD
Practice Address - Street 2:STE B2
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:760-347-8181
Practice Address - Fax:760-775-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2021-04-13
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
CA052658Medicare Oscar/Certification