Provider Demographics
NPI:1043265903
Name:URGIKIDS
Entity Type:Organization
Organization Name:URGIKIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUMBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-668-2510
Mailing Address - Street 1:PO BOX 15277
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92659-5277
Mailing Address - Country:US
Mailing Address - Phone:714-668-2540
Mailing Address - Fax:714-668-2510
Practice Address - Street 1:1190 BAKER ST
Practice Address - Street 2:100
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4108
Practice Address - Country:US
Practice Address - Phone:714-668-2540
Practice Address - Fax:714-668-2510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29438208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty