Healthcare Provider Details

I. General information

NPI: 1891786018
Provider Name (Legal Business Name): PROFESSIONAL UNITED DIALYSIS CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7403 HELLMAN AVE
ROSEMEAD CA
91770-2213
US

IV. Provider business mailing address

7403 HELLMAN AVE
ROSEMEAD CA
91770-2213
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-6161
  • Fax: 626-280-7887
Mailing address:
  • Phone: 626-280-6161
  • Fax: 626-280-7887

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 StateCA

VIII. Authorized Official

Name: MRS. MARY SHIH
Title or Position: ADMINISTRATOR
Credential:
Phone: 626-280-6161