Provider Demographics
NPI:1578775045
Name:AZUSA DIALYSIS CENTER LLC
Entity Type:Organization
Organization Name:AZUSA DIALYSIS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AAMIR
Authorized Official - Middle Name:ZAIN
Authorized Official - Last Name:JAMAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-542-2900
Mailing Address - Street 1:1335 CYPRESS STREET
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3537
Mailing Address - Country:US
Mailing Address - Phone:909-542-2900
Mailing Address - Fax:909-592-6000
Practice Address - Street 1:310 N AZUSA AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702-3439
Practice Address - Country:US
Practice Address - Phone:909-542-2900
Practice Address - Fax:909-592-6000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000357261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55-2573Medicare ID - Type UnspecifiedESRD