Provider Demographics
NPI:1770843633
Name:LONG BEACH QUEST DIALYSIS CENTER
Entity Type:Organization
Organization Name:LONG BEACH QUEST DIALYSIS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MEI MING AKA MARY
Authorized Official - Middle Name:WANG
Authorized Official - Last Name:SHIH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:626-318-0303
Mailing Address - Street 1:3140 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-5061
Mailing Address - Country:US
Mailing Address - Phone:562-988-8866
Mailing Address - Fax:
Practice Address - Street 1:3140 LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-5061
Practice Address - Country:US
Practice Address - Phone:562-988-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-24
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) TreatmentGroup - Single Specialty