Provider Demographics
NPI:1154197911
Name:SHIDBAN DIALYSIS ACCESS INC
Entity type:Organization
Organization Name:SHIDBAN DIALYSIS ACCESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIDBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-797-6044
Mailing Address - Street 1:1100 WILSHIRE BLVD APT 3101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1953
Mailing Address - Country:US
Mailing Address - Phone:213-797-6044
Mailing Address - Fax:213-481-7023
Practice Address - Street 1:1414 S GRAND AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3071
Practice Address - Country:US
Practice Address - Phone:213-797-6044
Practice Address - Fax:213-481-7023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty