Kiowa Dialysis LLC

Primary specialty

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

Legal business name

KIOWA DIALYSIS LLC

Practice address

14101 Francisquito Ave
Baldwin Park, CA 91706-6100

Phone

(626) 337-1847

Fax

(626) 337-0129

NPI assigned

Nov 3, 2016

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

• Baldwin Park Dialysis Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

DaVita Baldwin ParkCCN 552889

Overall star rating

4.0 of 5

Ownership

Profit

Certified

Dec 11, 2019

Medicare certification status

ActiveFrom the Provider of Services file

Chain

DaVita

Dialysis stations

25

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

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Napa, CA
  • NPI 1295024206

  Member Of

  NPD member

Locations

Affiliated clinicians 2

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

• Ranjit Alexius Cordeiro, M.D.

  • Nephrology Physician
  • Covina, CA
  • NPI 1417950957

  Dialysis facility

  Care Compare affiliation Name & address match
• Raffi R Minasian, MD

  • Nephrology Physician
  • Glendale, CA
  • NPI 1306860465

  Dialysis facility

  Care Compare affiliation Name & address match

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

{
    "created_epoch": "1478131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751414400000",
    "number": "1780136093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VIRGINIA WAY",
            "address_2": "ATT: 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": "14101 FRANCISQUITO AVE",
            "city": "BALDWIN PARK",
            "state": "CA",
            "postal_code": "917066100",
            "telephone_number": "626-337-1847",
            "fax_number": "626-337-0129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIOWA DIALYSIS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-03",
        "last_updated": "2025-07-02",
        "certification_date": "2025-06-16",
        "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": "Baldwin Park Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Baldwin Park Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Teri Yae Sul Kim, MD
• Woojae Kim, M.D.
• Young H. Kim, MD
• Brad Hiroshi Kimura, MD
• Claybourne D King, LCSW
• Brian Kit, OD
• Frances Lynn Lee Kita, M.D.
• KND Development 52, L.L.C.
• KND Development 59 LLC
• Jacqueline Y. Ko, MD

• All providers in Baldwin Park, CA
• 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 Jul 2, 2025; 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.