Organization
MK DIALYSIS CENTER AT RIVERSIDE, INC.
Active
Other names
Van buren Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MOHAMMED QUTUB KHAN MD (PRESIDENT/CFO)
(951) 735-1257
Entity
Organization
Contact information
Practice address
3595 VAN BUREN BLVD, SUITE 101, RIVERSIDE, CA 92503-0311
(909) 542-2900
Mailing address
3595 VAN BUREN BLVD, SUITE 101, RIVERSIDE, CA 92503-0311
(909) 542-2900
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245567627
NPI
CA
Enumeration date
11/05/2009
Last updated
07/11/2016
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