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MODESTO KIDNEY CENTER, INC.
NPI 1003887712
Clinic/Center - End-Stage Renal Disease (ESRD) Treatment in Modesto, CA

Active since January 30, 2006CLIA 05D0912738 · Waiver
305 E GRANGER AVE, MODESTO, CA 95350(209) 574-6800(209) 574-6808 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Modesto Kidney Center, Inc. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MODESTO KIDNEY CENTER, INC. (NPI 1003887712) is a healthcare organization registered as an end-stage renal disease (esrd) treatment in Modesto, California and active in the NPI registry since January 2006. The organization holds a CLIA Waiver certificate valid through March 10, 2028 and lists Jerry Green, Secretary, as its authorized official.

NPPES Registry Identity

NPI1003887712
Entity TypeOrganization
Primary Taxonomy261QE0700X
Legal Business NameMODESTO KIDNEY CENTER, INC.
Location Address305 E GRANGER AVEModesto, CA 95350-4345
Mailing Address1 World Trade Ctr, 2500Long Beach, CA 90831-0002 · (562) 495-8075 · Fax (562) 495-8076
Phone(209) 574-6800
Fax(209) 574-6808
Organization SubpartNo
Authorized OfficialJerry GreenSecretary · (562) 495-8075
Enumeration DateJanuary 30, 2006
Last NPPES UpdateAugust 22, 2020
✔ NPI 1003887712 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · End-Stage Renal Disease (ESRD) TreatmentAmbulatory Health Care Facilities
Taxonomy Code261QE0700X
305 E GRANGER AVE, Modesto, CA 95350
Open in Google Maps ↗

Other Identifiers 1

MedicaidCDC02783FCA

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 05D0912738

Modesto Kidney Center, LLC Dba: U.S. Renal Care Modesto Dialysis · Modesto, CA
Active · expires Mar 10, 2028
CLIA Number05D0912738
Laboratory TypeEnd Stage Renal Disease Dialysis Facility
Certificate Effective DateMarch 11, 2026
Certificate Expiration DateMarch 10, 2028
Laboratory DirectorChang Joo
Laboratory Phone(209) 574-6800
Laboratory LocationModesto Kidney Center, LLC Dba: U.S. Renal Care Modesto Dialysis305 East Granger Avenue Suite 102, Modesto, CA 95350
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MODESTO KIDNEY MEDICAL GROUP
Internal Medicine (Nephrology)
305 E GRANGER AVE, STE 202
MODESTO, CA 95350
Stanislaus County (209) 526-1606
KENNETH K LIU MD
Internal Medicine (Nephrology)
305 E GRANGER AVE, STE 202
MODESTO, CA 95350
Stanislaus County (209) 526-1606
CHANG S JOO MD
Internal Medicine (Nephrology)
305 E GRANGER AVE, STE 202
MODESTO, CA 95350
Stanislaus County (209) 526-1606
KRIENGSAK ITSARA MD
Internal Medicine (Nephrology)
305 E GRANGER AVE, STE 202
MODESTO, CA 95350
Stanislaus County (206) 526-1606
TONG SUN MD
Internal Medicine (Nephrology)
305 E GRANGER AVE, STE 202
MODESTO, CA 95350
Stanislaus County (209) 526-1606

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Modesto Kidney Center, Inc.'s NPI number?

The NPI number for Modesto Kidney Center, Inc. is 1003887712. It was assigned to this organization in the NPPES registry on January 30, 2006.

Where is Modesto Kidney Center, Inc. located?

Modesto Kidney Center, Inc. is located at 305 E Granger Ave, Modesto, CA 95350. The listed phone number is (209) 574-6800.

What is Modesto Kidney Center, Inc.'s specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment, with taxonomy code 261QE0700X.

Does Modesto Kidney Center, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 05D0912738) is associated with this NPI, valid through March 10, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Modesto Kidney Center, Inc. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.