Provider Demographics
NPI:1356549455
Name:DIALYSIS CENTER OF ONTARIO LLC
Entity type:Organization
Organization Name:DIALYSIS CENTER OF ONTARIO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HLA
Authorized Official - Middle Name:MYINT
Authorized Official - Last Name:MAUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-981-5882
Mailing Address - Street 1:536 E. FOOTHILL BLVD,
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786
Mailing Address - Country:US
Mailing Address - Phone:909-981-5882
Mailing Address - Fax:909-946-0833
Practice Address - Street 1:2850 INLAND EMPIRE BLVD STE C
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4659
Practice Address - Country:US
Practice Address - Phone:909-476-2638
Practice Address - Fax:909-946-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA552613Medicare Oscar/Certification