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General NPI Number Information
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NPI Number | 1558320366
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Entity Type | Organization
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Legal Business Name | LOS ANGELES DIALYSIS CENTER
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 3901 S WESTERN AVE
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City | LOS ANGELES
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State | CA
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Zip | 90062-1112
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Country | US
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Telephone | 323-294-1310
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Fax | 323-294-4034
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Provider Business Mailing Address
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Address Line | 5200 VIRGINIA WAY SUTIE 400 L&C
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City | BRENTWOOD
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State | TN
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Zip | 37027-7569
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Country | US
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Telephone | 615-341-5895
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Fax | 866-890-5560
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Authorized Official
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Title or Position | CHIEF ACCOUNTING OFFICER
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Name | JAMES K HILGER
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Credential |
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Telephone | 253-382-1919
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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 | 930000446
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License Number State | CA
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