Peritoneal Dialysis Center of America - San Gabriel, PC

Primary specialty

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

Legal business name

PERITONEAL DIALYSIS CENTER OF AMERICA - SAN GABRIEL, PC

Practice address

809 S Atlantic Blvd
Suite 103
Monterey Park, CA 91754-4756

Phone

(626) 576-8556

Fax

(626) 576-8557

NPI assigned

Aug 13, 2012

Organization subpart

No

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

Authorized official

Name

Pradip C.P. Chowdhury, MD

Title

Owner

Phone

(323) 371-4182

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Peritoneal Dialysis Center of America-San Gabriel PCCCN 052684

Overall star rating

1.0 of 5

Ownership

Profit

Certified

Jul 22, 1989

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Kay Khine Kyaw, M.D.

  • Nephrology Physician
  • Montebello, CA
  • NPI 1912223850

  Dialysis facility

  Care Compare affiliation Name & address match
• Lathika Raakesh, MD

  • Nephrology Physician
  • Montebello, CA
  • NPI 1497048672

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1344816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692576000000",
    "number": "1093062796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 S ATLANTIC BLVD",
            "address_2": "SUITE 103",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917544756",
            "telephone_number": "626-576-8556",
            "fax_number": "626-576-8557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 S ATLANTIC BLVD",
            "address_2": "SUITE 103",
            "city": "MONTEREY PARK",
            "state": "CA",
            "postal_code": "917544756",
            "telephone_number": "626-576-8556",
            "fax_number": "626-576-8557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PERITONEAL DIALYSIS CENTER OF AMERICA - SAN GABRIEL, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-13",
        "last_updated": "2023-08-21",
        "certification_date": "2023-07-12",
        "status": "A",
        "authorized_official_last_name": "CHOWDHURY",
        "authorized_official_first_name": "PRADIP",
        "authorized_official_middle_name": "C.P.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "323-371-4182",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1093062796",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Tim Peng, OTR/L
• Hui Fang B. Peng, L.AC.
• Cynthia Perez
• Esperansa Perez, LCSW
• Lilliana Perez
• Maria Petrova Pesheva, M.D.
• Peter M. Kam, DDS, Inc
• Daniel Robert Petrosian, RADT
• Pharm Works RX, Inc
• Philip Y. Zhuo, M.D. Inc.

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Monterey Park, CA
• Providers in Monterey Park, 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 Aug 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.