Organization Active NPI

West Coast Dialysis Center, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Long Beach, CA
National Provider Identifier
1457323677
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
WEST COAST DIALYSIS CENTER, INC.
Practice address
3780 Kilroy Airport Way
110
Long Beach, CA 90806-2457
Phone
(562) 989-3010
Fax
(562) 989-3016
NPI assigned
Feb 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Jerry Green
Title
Secretary
Phone
(562) 495-8075

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X CA Primary

Addresses

Primary practice location

3780 Kilroy Airport Way
110
Long Beach, CA 90806-2457

Mailing address

1 World Trade Ctr
2500
Long Beach, CA 90831-0002
Phone (562) 495-8075

Other identifiers 1

IdentifierTypeStateIssuer
CDC02747FMedicaidCA

National Provider Directory

National Provider Directory

Locations

3780 Kilroy Airport Way
Long Beach, CA 90806
Phone (562) 424-6015

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1457323677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 WORLD TRADE CTR",
            "address_2": "2500",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908310002",
            "telephone_number": "562-495-8075",
            "fax_number": "562-495-8076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3780 KILROY AIRPORT WAY",
            "address_2": "110",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908062457",
            "telephone_number": "562-989-3010",
            "fax_number": "562-989-3016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST COAST DIALYSIS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JERRY",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "562-495-8075",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CDC02747F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Long Beach, CA

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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.