Coral Dialysis LLC

Primary specialty

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

Legal business name

CORAL DIALYSIS LLC

Doing business as

Port City Dialysis

Practice address

1810 S Fresno Ave
Stockton, CA 95206-1861

Phone

(209) 946-0738

Fax

(209) 946-0827

NPI assigned

Apr 29, 2014

Last updated

Oct 20, 2026By the provider in NPPES

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 names 1

• Port City Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Port City DialysisCCN 552808

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Mar 22, 2017

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

24

Member of 1

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

• Total Renal Care Inc

  dba Kendall Kidney Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Miami, FL
  • NPI 1164748273

  Member Of

  NPD member

Affiliated clinicians 4

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

• Mallareddy Maddula, M.D.

  • Nephrology Physician
  • Stockton, CA
  • NPI 1487762647

  Dialysis facility

  Care Compare affiliation Name & address match
• Subrahmanyam Nasika, M.D.

  • Nephrology Physician
  • Stockton, CA
  • NPI 1548449846

  Dialysis facility

  Care Compare affiliation Name & address match
• Lan Ngoc Quang, M.D.

  • Internal Medicine Physician
  • Stockton, CA
  • NPI 1437354347

  Dialysis facility

  Care Compare affiliation Name & address match
• Mehul Raval, MD

  • Nephrology Physician
  • Stockton, CA
  • NPI 1710157474

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1398729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792454400000",
    "number": "1437569514",
    "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": "1810 S FRESNO AVE",
            "city": "STOCKTON",
            "state": "CA",
            "postal_code": "952061861",
            "telephone_number": "209-946-0738",
            "fax_number": "209-946-0827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORAL DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-29",
        "last_updated": "2026-10-20",
        "certification_date": "2026-10-20",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port City Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jazmine Michelle Cooper
• Tianna Cooper
• Jamie Sue Copeland
• Amy Marie Coppel
• Johnna Coppock, RD
• Sharon Corbin, APRN
• Tyera Cord
• Joy Helene Cordaway
• Giyana Elizabeth Cordero
• Marie Anthonie Peralta Cordero

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Stockton, CA
• Providers in Stockton, 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 Oct 20, 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.