Active NPI
Kidney Care a Medical Corp
- Nephrology Physician
- Los Angeles, CA
National Provider Identifier
1184737561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- A47826
- Legal business name
- KIDNEY CARE A MEDICAL CORP
- Practice address
- 8540 S Sepulveda Blvd Ste 1100
Los Angeles, CA 90045-3819 - Phone
- (310) 914-9150
- Fax
- (310) 914-9705
- NPI assigned
- Aug 17, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Bialick Tabibian
- Title
- Medical Doctor
- Phone
- (310) 914-9150
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | A47826 | CA | Primary |
Addresses
Primary practice location
8540 S Sepulveda Blvd Ste 1100
Los Angeles, CA 90045-3819
Mailing address
PO Box 25427
Los Angeles, CA 90025-0427
Phone (310) 914-9150
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A478261 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20101123000018 | CA | Part B Supplier - Clinic/Group Practice | 1557557105 | Practice locations: Los Angeles, CA |
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1184737561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 25427",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900250427",
"telephone_number": "310-914-9150",
"fax_number": "310-914-9705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8540 S SEPULVEDA BLVD STE 1100",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900453819",
"telephone_number": "310-914-9150",
"fax_number": "310-914-9705"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "KIDNEY CARE A MEDICAL CORP",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-17",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "TABIBIAN",
"authorized_official_first_name": "BIALICK",
"authorized_official_title_or_position": "MEDICAL DOCTOR",
"authorized_official_telephone_number": "310-914-9150"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Nephrology",
"state": "CA",
"license": "A47826",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A478261",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
- Jamie Lynn Kidd
- Nikia Kidd
- Shirley Kidd, R.N.
- Elizabeth Kidde, CPNP
- Nadia Lorraine Kidiwa
- Kidney Care Institute Inc
- Kidney Center of Los Angeles, LLC (U.S. Renal Care Los Angeles Dialysis)
- Kidney Dialysis Center of Baldwin Hills LLC
- Kidney Dialysis Center of West Los Angeles
- Kidney Transplant Associates
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.