Provider Demographics
NPI:1891786018
Name:PROFESSIONAL UNITED DIALYSIS CENTER INC.
Entity Type:Organization
Organization Name:PROFESSIONAL UNITED DIALYSIS CENTER INC.
Other - Org Name:ROSEMEAD DIALYSIS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-280-6161
Mailing Address - Street 1:7403 HELLMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-2213
Mailing Address - Country:US
Mailing Address - Phone:626-280-6161
Mailing Address - Fax:626-280-7887
Practice Address - Street 1:7403 HELLMAN AVE
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-2213
Practice Address - Country:US
Practice Address - Phone:626-280-6161
Practice Address - Fax:626-280-7887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QE0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACDC02791FMedicaid
CACDC02791FMedicaid