1023534328 NPI number — GK URGI CARE INC

Table of content: (NPI 1023534328)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023534328 NPI number — GK URGI CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GK URGI CARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SJ MEDICAL CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023534328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
422 N SAN JACINTO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEMET
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92543-3124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-566-6585
Provider Business Mailing Address Fax Number:
888-696-2590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 N SAN JACINTO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEMET
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92543-3124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-566-6585
Provider Business Practice Location Address Fax Number:
888-696-2590
Provider Enumeration Date:
08/17/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KOKA
Authorized Official First Name:
VIDHYA
Authorized Official Middle Name:
VENKATA
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
951-566-6585

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A60823 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)