Organization
ANTELOPE VALLEY DIALYSIS CENTER MEDICAL GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GHASSAN S DAHHAN M.D. (ADMINISTRATOR)
(661) 267-7645
Entity
Organization
Contact information
Practice address
1759 W AVENUE J # 102, LANCASTER, CA 93534-2703
(661) 942-6400
(661) 729-3985
Mailing address
1643 E PALMDALE BLVD, PALMDALE, CA 93550-4847
(661) 267-7645
(661) 267-6464
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
05
—
ZZT11810G
—
CA
Enumeration date
09/15/2006
Last updated
07/10/2007
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