=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699852327
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DIALYSIS ACCESS CENTER A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 10/12/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3012 SUMMIT ST D WING
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94609-3480
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-251-1002
-----------------------------------------------------
Fax | 510-251-1034
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 883528
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90088-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-251-1002
-----------------------------------------------------
Fax | 510-251-1034
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | MR. THOMAS TURNER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-251-1002
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------