# SHIDBAN DIALYSIS ACCESS INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154197911
- **Authorized official:** HAMID SHIDBAN MD (OWNER)
- **Authorized official phone:** (213) 797-6044

## Contact information

- **Practice address:** 1414 S GRAND AVE STE 100, LOS ANGELES, CA 90015-3071
- **Practice address phone:** (213) 797-6044
- **Practice address fax:** (213) 481-7023
- **Mailing address:** 1100 WILSHIRE BLVD APT 3101, LOS ANGELES, CA 90017-1953
- **Mailing address phone:** (213) 797-6044
- **Mailing address fax:** (213) 481-7023

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 204F00000X | Transplant Surgery Physician | — | NULL | Yes |
| 204F00000X | Transplant Surgery Physician | — | — | Yes |
| 2086S0129X | Vascular Surgery Physician | — | NULL | — |
| 2086S0129X | Vascular Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 12/01/2023
- **Last updated:** 12/01/2023