Provider Demographics
NPI:1750495669
Name:PERITONEAL DIALYSIS CENTER OF AMERICA, INC
Entity Type:Organization
Organization Name:PERITONEAL DIALYSIS CENTER OF AMERICA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRADIP
Authorized Official - Middle Name:CP
Authorized Official - Last Name:CHOWDHURY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-371-4182
Mailing Address - Street 1:3112 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-2217
Mailing Address - Country:US
Mailing Address - Phone:323-722-2053
Mailing Address - Fax:323-722-2063
Practice Address - Street 1:3112 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-2217
Practice Address - Country:US
Practice Address - Phone:323-722-2053
Practice Address - Fax:323-722-2063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA79279OtherKAVITHA KANAKARAJ, MD
CAQ56438Medicare UPIN
CAA28171Medicare UPIN
CAP50772Medicare UPIN
CAA79279OtherKAVITHA KANAKARAJ, MD
CAH18737Medicare UPIN
CAF01869Medicare UPIN
CAQ56774Medicare UPIN