Kidney Connect PLLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

Legal business name

KIDNEY CONNECT PLLC

Practice address

1402 N 4TH St
Longview, TX 75601-4774

Phone

(903) 234-9992

NPI assigned

Nov 8, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Glenn McDonald, MD

Title

Physician

Phone

(903) 234-9992

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1541635200000",
    "number": "1063980936",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1402 N 4TH ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756014774",
            "telephone_number": "903-234-9992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1402 N 4TH ST",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756014774",
            "telephone_number": "903-234-9992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY CONNECT PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-08",
        "last_updated": "2018-11-08",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "GLENN",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "903-234-9992",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135880608",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152080101",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114429704",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Malasha Khan, MD
• Rashad Mumtaz Khan, M.D.
• Sanum Khan
• Mohammad Khatib
• Arti Khatri, MD
• Kilea L Johnson FNP, P.a.
• Jae Kyong Kim, DDS
• Tony Kim, D.D.S.
• Kristin Michele Kimbro
• Kindstar, Inc.

• Nephrology Physician in Longview, TX
• Providers in Longview, TX by specialty
• Nephrology Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.