Healthcare Provider Details

I. General information

NPI: 1154299394
Provider Name (Legal Business Name): KPC-PC DIALYSIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2025
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 E DEVONSHIRE AVE
HEMET CA
92543-3083
US

IV. Provider business mailing address

9 KPC PKWY STE 301
CORONA CA
92879-7102
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-2811
  • Fax:
Mailing address:
  • Phone: 562-405-4520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0700X
TaxonomyEnd-Stage Renal Disease (ESRD) Treatment Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PRADIP C CHOWDHURY
Title or Position: CEO
Credential: MD
Phone: 323-371-4182