1093911430 NPI number — LAS VEGAS KIDNEY SPECIALISTS JANGA LLP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093911430 NPI number — LAS VEGAS KIDNEY SPECIALISTS JANGA LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAS VEGAS KIDNEY SPECIALISTS JANGA LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093911430
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7000 SMOKE RANCH ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-202-3431
Provider Business Mailing Address Fax Number:
702-202-3455

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5945 S RAINBOW BOULEVARD
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-588-7077
Provider Business Practice Location Address Fax Number:
702-588-7079
Provider Enumeration Date:
06/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JANGA
Authorized Official First Name:
RADHIKA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
702-202-3431

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  10554 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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