Provider Demographics
NPI:1548206402
Name:KIDNEY DIALYSIS CENTER OF WEST LOS ANGELES
Entity Type:Organization
Organization Name:KIDNEY DIALYSIS CENTER OF WEST LOS ANGELES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT/GENERAL COUNS
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-736-2730
Mailing Address - Street 1:2400 DALLAS PKWY
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4370
Mailing Address - Country:US
Mailing Address - Phone:214-736-2700
Mailing Address - Fax:214-735-2701
Practice Address - Street 1:1801 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-4641
Practice Address - Country:US
Practice Address - Phone:310-840-8688
Practice Address - Fax:805-433-7655
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:U.S. RENAL CARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-21
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000908261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC02809FMedicaid
CACDC02809FMedicaid