Organization
CHILDRENS KIDNEY SPECIALISTS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDALL JENKINS MD (DOCTOR)
(208) 381-7336
Entity
Organization
Contact information
Practice address
100 E IDAHO ST, 200, BOISE, ID 83712-6223
(208) 381-7336
(208) 381-7495
Mailing address
1935 NW NORFOLK CT, PORTLAND, OR 97229-8448
(503) 297-3178
(208) 381-7495
Taxonomy
Speciality
Code
Description
License number
State
2080P0210X
Pediatric Nephrology Physician
Primary
M6943
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010026970
BLUE SHIELD
ID
05
—
003401500
—
ID
Enumeration date
05/31/2007
Last updated
06/20/2012
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