Kidney Dialysis Center of San Luis Obispo,LLC

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

KIDNEY DIALYSIS CENTER OF SAN LUIS OBISPO,LLC

Practice address

1043 Marsh St
San Luis Obispo, CA 93401-3629

Phone

(805) 543-1013

Fax

(805) 543-5654

NPI assigned

Jun 13, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lisa Viral Upponi

Title

Director of Accounts Receivable

Phone

(805) 433-7506

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199664000000",
    "number": "1033151816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 940838",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930940838",
            "telephone_number": "805-443-7777",
            "fax_number": "805-433-7655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1043 MARSH ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934013629",
            "telephone_number": "805-543-1013",
            "fax_number": "805-543-5654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDNEY DIALYSIS CENTER OF SAN LUIS OBISPO,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2008-01-07",
        "status": "A",
        "authorized_official_last_name": "UPPONI",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "VIRAL",
        "authorized_official_title_or_position": "DIRECTOR OF ACCOUNTS RECEIVABLE",
        "authorized_official_telephone_number": "805-433-7506",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "ZZZ02842Z",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CDC02811G",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Parzych a Medical Corp
• John A Khan-Variba, MD
• Elham Khodabandeloo, L.AC.
• Kallie Elizabeth Kidder
• Lani Kidman
• Kristen Wikholm Kieley, M.D.
• Daniel Kielty, LVN
• George S Kienle, DO
• Yusuke Kihira, DPM
• Christine Denise Kilcline, M.D.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.