Provider Demographics
NPI:1720630304
Name:KPC GLOBAL DIALYSIS CENTER OF LOS ANGELES LLC
Entity Type:Organization
Organization Name:KPC GLOBAL DIALYSIS CENTER OF LOS ANGELES LLC
Other - Org Name:GLOBAL DIALYSIS CENTER OF LOS ANGELES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-987-8100
Mailing Address - Street 1:9 KPC PKWY STE 301
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-7102
Mailing Address - Country:US
Mailing Address - Phone:951-987-8100
Mailing Address - Fax:
Practice Address - Street 1:201 S ALVARADO ST STE 220
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2388
Practice Address - Country:US
Practice Address - Phone:213-484-7425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment