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General NPI Number Information
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NPI Number | 1154197911
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Entity Type | Organization
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Legal Business Name | SHIDBAN DIALYSIS ACCESS INC
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Dates
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Enumeration Date | 12/01/2023
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Last Update Date | 12/01/2023
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Provider Practice Location Address
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Address Line | 1414 S GRAND AVE STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90015-3071
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Country | US
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Telephone | 213-797-6044
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Fax | 213-481-7023
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Provider Business Mailing Address
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Address Line | 1100 WILSHIRE BLVD APT 3101
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City | LOS ANGELES
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State | CA
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Zip | 90017-1953
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Country | US
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Telephone | 213-797-6044
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Fax | 213-481-7023
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Authorized Official
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Title or Position | OWNER
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Name | HAMID SHIDBAN
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Credential | MD
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Telephone | 213-797-6044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 204F00000X
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Taxonomy Name | Transplant Surgery Physician
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License Number |
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License Number State |
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