Provider Demographics
NPI:1770520488
Name:ONTARIO DIALYSIS CENTER,INC
Entity type:Organization
Organization Name:ONTARIO DIALYSIS CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ABID
Authorized Official - Middle Name:HAMEED
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-984-0320
Mailing Address - Street 1:1001 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-1209
Mailing Address - Country:US
Mailing Address - Phone:909-984-0320
Mailing Address - Fax:909-984-2213
Practice Address - Street 1:1001 W 6TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1209
Practice Address - Country:US
Practice Address - Phone:909-984-0320
Practice Address - Fax:909-984-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2016-10-18
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
CA00A538060Medicare PIN
CAG42562Medicare UPIN
CA552596Medicare Oscar/Certification