Active NPI
Home Dialysis Services of Sandusky Inc.
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Sandusky, OH
National Provider Identifier
1710910674
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- HOME DIALYSIS SERVICES OF SANDUSKY INC.
- Practice address
- 2819 Hayes Ave
Suite 2
Sandusky, OH 44870-5391 - Phone
- (419) 627-8403
- Fax
- (419) 627-1962
- NPI assigned
- Jul 7, 2006
- Organization subpart
- Yes
- Parent organization
- HOME DIALYSIS SERVICES OF SANDUSKY, INC.
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gwang Och Kim, MD
- Title
- President
- Phone
- (419) 627-0477
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Primary |
Addresses
Primary practice location
2819 Hayes Ave
Suite 2
Sandusky, OH 44870-5391
Mailing address
2819 Hayes Ave Ste 8
Sandusky, OH 44870-5391
Phone (419) 627-0477
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000340065 | Other | OH | ANTHEM |
| 2472104 | Medicaid | OH |
National Provider Directory
National Provider Directory- Part of
- Home Dialysis Services of Sandusky Inc
Locations
2819 Hayes Ave
Ste 2
Sandusky, OH 44870
Phone (419) 627-0477
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Nephrology Physician
- Sandusky, OH
- NPI 1629077029
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1576195200000",
"number": "1710910674",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2819 HAYES AVE STE 8",
"city": "SANDUSKY",
"state": "OH",
"postal_code": "448705391",
"telephone_number": "419-627-0477",
"fax_number": "419-627-0466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2819 HAYES AVE",
"address_2": "SUITE 2",
"city": "SANDUSKY",
"state": "OH",
"postal_code": "448705391",
"telephone_number": "419-627-8403",
"fax_number": "419-627-1962"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HOME DIALYSIS SERVICES OF SANDUSKY INC.",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "HOME DIALYSIS SERVICES OF SANDUSKY, INC.",
"enumeration_date": "2006-07-07",
"last_updated": "2019-12-13",
"certification_date": "2019-12-13",
"status": "A",
"authorized_official_last_name": "KIM",
"authorized_official_first_name": "GWANG",
"authorized_official_middle_name": "OCH",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "419-627-0477",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000340065",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2472104",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sandusky, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.