Olive Dialysis LLC

Primary specialty

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

Legal business name

OLIVE DIALYSIS LLC

Practice address

9848 Atlantic Ave
South Gate, CA 90280-5219

Phone

(323) 569-1035

Fax

(323) 569-1790

NPI assigned

Jun 4, 2015

Organization subpart

No

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

Authorized official

Name

Samuel Wey

Title

VP Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• South Gate Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita South Gate DialysisCCN 552821

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Oct 18, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

25

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

CLIA laboratory certificates

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Total Renal Care Inc

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Castle Rock, CO
  • NPI 1386928430

  Member Of

  NPD member

Affiliated clinicians 4

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

• Antiem Bui, D.O.

  • Nephrology Physician
  • Lakewood, CA
  • NPI 1336569300

  Dialysis facility

  Care Compare affiliation Name & address match
• Wen-Yuan Marieanne Chiang, D.O.

  • Nephrology Physician
  • South Gate, CA
  • NPI 1295753655

  Dialysis facility

  Care Compare affiliation Name & address match
• George G Hon, MD

  • Nephrology Physician
  • Paramount, CA
  • NPI 1699772350

  Dialysis facility

  Care Compare affiliation Name & address match
• Malvin Yan, D.O.

  • Nephrology Physician
  • South Gate, CA
  • NPI 1033153101

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1433376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723593600000",
    "number": "1184004137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "L&C DEPT",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370277569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9848 ATLANTIC AVE",
            "city": "SOUTH GATE",
            "state": "CA",
            "postal_code": "902805219",
            "telephone_number": "323-569-1035",
            "fax_number": "323-569-1790"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLIVE DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-04",
        "last_updated": "2024-08-14",
        "certification_date": "2024-08-14",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "VP LICENSURE & CERTIFICATION",
        "authorized_official_telephone_number": "615-341-6641"
    },
    "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": "1184004137",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Gate Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "South Gate Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sepideh Noroozi, D.D.S.
• Lilia M Nunez, DDS
• Occupational Health Centers of California, a Medical Corporation
• Christopher Ofori
• Nickolas Olabode
• Omar Jesus Fernandez DDS Inc
• Alan Martin Ordaz, SLPA
• Julio Cesar Orellana, RDA
• Grace Origel, NP
• Esmeralda Orozco, LVN

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in South Gate, CA
• Providers in South Gate, 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 14, 2024; 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.