Cinco Rios Dialysis LLC

Primary specialty

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

License

550002070 Issued in CA

Legal business name

CINCO RIOS DIALYSIS LLC

Doing business as

Sun City Menifee Dialysis

Practice address

1702 Illinois Ave
Perris, CA 92571-9371

Phone

(951) 928-1369

Fax

(951) 928-2150

NPI assigned

Feb 24, 2012

Organization subpart

No

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

Authorized official

Name

Samuel T. Wey

Title

VP, Licensure & Certification

Phone

(615) 341-6641

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Sun City Menifee Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Sun City Menifee DialysisCCN 552715

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Nov 16, 2012

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

24

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

  dba Edgewater Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Rockfrd, IL
  • NPI 1154997591

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph Tubbs

  • Renal Nutrition Registered Dietitian
  • Perris, CA
  • NPI 1528684016
  NPD (past)

Affiliated clinicians 2

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

• Peter Lac, M.D.

  • Nephrology Physician
  • Wildomar, CA
  • NPI 1881617652

  Dialysis facility

  Care Compare affiliation Name & address match
• Eric Yan

  • Nephrology Physician
  • Menifee, CA
  • NPI 1225115892

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1330041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772064000000",
    "number": "1225302128",
    "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": "1702 ILLINOIS AVE",
            "city": "PERRIS",
            "state": "CA",
            "postal_code": "925719371",
            "telephone_number": "951-928-1369",
            "fax_number": "951-928-2150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CINCO RIOS DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-24",
        "last_updated": "2026-02-26",
        "certification_date": "2026-02-26",
        "status": "A",
        "authorized_official_last_name": "WEY",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "T.",
        "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": "CA",
            "license": "550002070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1225302128",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sun City Menifee Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Sun City Menifee Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angela Christensen, RDN, CDCES
• Beverly Christian
• Chung Kim DDS, Inc
• Monica Katherine Chungchu
• Jason Scott Chvat, PHARM.D.
• City of the Heart Psychological Service, a Professional Corporation
• Claravision Optometry
• Ashley Lorraine Closser
• Clay Collier, SLP
• Katie Collins, NP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Perris, CA
• Providers in Perris, 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 Feb 26, 2026; 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.