Provider Demographics
NPI:1710923677
Name:KIDNEY CENTER OF SHERMAN OAKS, INC.
Entity Type:Organization
Organization Name:KIDNEY CENTER OF SHERMAN OAKS, INC.
Other - Org Name:U.S. RENAL CARE SHERMAN OAKS DIALYSIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
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:214-736-2700
Mailing Address - Street 1:PO BOX 251549
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-1500
Mailing Address - Country:US
Mailing Address - Phone:214-736-2700
Mailing Address - Fax:
Practice Address - Street 1:4955 VAN NUYS BLVD
Practice Address - Street 2:SUITE # 111
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1801
Practice Address - Country:US
Practice Address - Phone:818-285-5913
Practice Address - Fax:818-285-5917
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:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000991261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC52507FMedicaid
CAZZZR0127ZOtherBLUE SHIELD
CA552507Medicare Oscar/Certification