# ALASKA KIDNEY & DIABETES ASSOCIATION

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Other names:** Bongo Medical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619935558
- **Authorized official:** DR. LESLIE A. GLASGOW MD (CEO)
- **Authorized official phone:** (907) 569-1049

## Contact information

- **Practice address:** 3260 PROVIDENCE DR, \#523, ANCHORAGE, AK 99508-4608
- **Practice address phone:** (907) 569-1049
- **Practice address fax:** (907) 563-4564
- **Mailing address:** 3260 PROVIDENCE DR, \#523, ANCHORAGE, AK 99508-4608
- **Mailing address phone:** (907) 569-1049
- **Mailing address fax:** (907) 563-4564

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 207RN0300X | Nephrology Physician | — | — | — |

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 01/03/2013