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General NPI Number Information
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NPI Number | 1245567627
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Entity Type | Organization
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Legal Business Name | MK DIALYSIS CENTER AT RIVERSIDE, INC.
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Dates
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Enumeration Date | 11/05/2009
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 3595 VAN BUREN BLVD SUITE 101
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City | RIVERSIDE
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State | CA
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Zip | 92503-0311
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Country | US
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Telephone | 909-542-2900
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Fax |
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Provider Business Mailing Address
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Address Line | 3595 VAN BUREN BLVD SUITE 101
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City | RIVERSIDE
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State | CA
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Zip | 92503-0311
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Country | US
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Telephone | 909-542-2900
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/CFO
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Name | MR. MOHAMMED QUTUB KHAN
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Credential | MD
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Telephone | 951-735-1257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0700X
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Taxonomy Name | End-Stage Renal Disease (ESRD) Treatment Clinic/Center
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License Number |
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License Number State |
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