Provider Demographics
NPI:1962050757
Name:EVN DIALYSIS CENTER, LLC
Entity type:Organization
Organization Name:EVN DIALYSIS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GUNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAHROMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-457-3949
Mailing Address - Street 1:18040 SHERMAN WAY STE 100
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-4656
Mailing Address - Country:US
Mailing Address - Phone:818-457-3949
Mailing Address - Fax:818-609-0076
Practice Address - Street 1:18040 SHERMAN WAY STE 100
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4656
Practice Address - Country:US
Practice Address - Phone:818-457-3949
Practice Address - Fax:818-609-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-27
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA001OtherN/A