Healthcare Provider Details

I. General information

NPI: 1104111491
Provider Name (Legal Business Name): KIDNEY DIALYSIS CENTER OF BALDWIN HILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 08/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3705 S LA BREA AVE
LOS ANGELES CA
90016-5309
US

IV. Provider business mailing address

PO BOX 940838
SIMI VALLEY CA
93094-0838
US

V. Phone/Fax

Practice location:
  • Phone: 323-293-4488
  • Fax: 323-293-4499
Mailing address:
  • Phone: 805-433-7777
  • 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: MANISHA PATEL
Title or Position: AR DIRECTOR
Credential:
Phone: 805-433-7555