MEDICARE: LONG BEACH QUEST DIALYSIS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1770843633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONG BEACH QUEST DIALYSIS CENTER

Provider Business Mailing Address
First Line	:	3140 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5061
Country	:	US
Telephone Number	:	562-988-8866
Fax Number	:

Provider Business Practice Location Address
First Line	:	3140 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-5061
Country	:	US
Telephone Number	:	562-988-8866
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATION
Name	:	MEI MING AKA MARY WANG SHIH
Credential	:	RN
Telephone Number	:	626-318-0303

Provider Enumeration Date	:	05/24/2012
Last Update Date	:	05/02/2019

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