Provider Demographics
NPI:1972677755
Name:DIALYSIS ACCESS CENTER, INC
Entity Type:Organization
Organization Name:DIALYSIS ACCESS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIVER
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHAKMAHD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-251-1002
Mailing Address - Street 1:3012 SUMMIT ST
Mailing Address - Street 2:D WING
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3480
Mailing Address - Country:US
Mailing Address - Phone:510-251-1002
Mailing Address - Fax:510-251-1034
Practice Address - Street 1:3012 SUMMIT ST
Practice Address - Street 2:D WING
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3480
Practice Address - Country:US
Practice Address - Phone:510-251-1002
Practice Address - Fax:510-251-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01612FMedicaid
CAZZZ25461ZMedicare ID - Type UnspecifiedASC #