Hacienda Dialysis Center, a Medical Corp.

Primary specialty

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

License

930000972 Issued in CA

Legal business name

HACIENDA DIALYSIS CENTER, A MEDICAL CORP.

Practice address

2020 S Hacienda Blvd
Hacienda Heights, CA 91745-4265

Phone

(626) 968-9558

Fax

(626) 968-7787

NPI assigned

Nov 4, 2005

Last updated

Feb 19, 2008By 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

Mrs. Mary Shih

Title

Administrator

Phone

(626) 968-9558

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Hacienda Dialysis CenterCCN 052879

Overall star rating

3.0 of 5

Ownership

Profit

Certified

Dec 17, 2001

Medicare certification status

ActiveFrom the Provider of Services file

Dialysis stations

19

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

CLIA laboratory certificates

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Tiffany Chiu

  • Renal Nutrition Registered Dietitian
  • Rosemead, CA
  • NPI 1073481156
  NPD (past)
• Chao-Ming Craig Lu, M.D.

  • Nephrology Physician
  • Hacienda Heights, CA
  • NPI 1871515163
  NPD (past)

Affiliated clinicians 1

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

• Chao-Ming Craig Lu, M.D.

  • Nephrology Physician
  • Hacienda Heights, CA
  • NPI 1871515163

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1131062400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203379200000",
    "number": "1457342677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2020 S HACIENDA BLVD",
            "city": "HACIENDA HEIGHTS",
            "state": "CA",
            "postal_code": "917454265",
            "telephone_number": "626-968-9558",
            "fax_number": "626-968-7787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2020 S HACIENDA BLVD",
            "city": "HACIENDA HEIGHTS",
            "state": "CA",
            "postal_code": "917454265",
            "telephone_number": "626-968-9558",
            "fax_number": "626-968-7787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HACIENDA DIALYSIS CENTER, A MEDICAL CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-04",
        "last_updated": "2008-02-19",
        "status": "A",
        "authorized_official_last_name": "SHIH",
        "authorized_official_first_name": "MARY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "626-968-9558",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "CA",
            "license": "930000972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CDC02879F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hector Rene Gutierrez
• Jocelyn Gutierrez
• H&H Harper Pharmacy Corporation (Puente Hills Pharmacy)
• Kimberly Haas
• Hacienda Center Pharmacy (Super Pharmacy)
• Abraham P Han, M.D.
• Eva Han, PHARM.D.
• Evaline Han
• Mei-Chuan Han
• Susana S Han, MA, CCC-SLP

• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Hacienda Heights, CA
• Providers in Hacienda Heights, 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 19, 2008; 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.