Basic Information
| Provider Information | |||||||||
| NPI: | 1720630304 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KPC GLOBAL DIALYSIS CENTER OF LOS ANGELES LLC | ||||||||
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| OtherOrganizationName: | GLOBAL DIALYSIS CENTER OF LOS ANGELES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 KPC PKWY STE 301 | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928797102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9519878100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 S ALVARADO ST STE 220 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900572388 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134847425 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2019 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | SECRETARY | ||||||||
| AuthorizedOfficialTelephone: | 9519878100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0700X | Y | Ambulatory Health Care Facilities | Clinic/Center | End-Stage Renal Disease (ESRD) Treatment |
No ID Information.