Provider Demographics
NPI:1093238107
Name:GK URGI CARE INC
Entity Type:Organization
Organization Name:GK URGI CARE INC
Other - Org Name:DR KOKA'S CLINIC INSIDE WALMART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIDHYA
Authorized Official - Middle Name:VENKATA
Authorized Official - Last Name:KOKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-566-6585
Mailing Address - Street 1:422 N SAN JACINTO ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3124
Mailing Address - Country:US
Mailing Address - Phone:951-566-6585
Mailing Address - Fax:888-696-2590
Practice Address - Street 1:1861 S SAN JACINTO AVE
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-5605
Practice Address - Country:US
Practice Address - Phone:951-566-6585
Practice Address - Fax:888-696-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-20
Last Update Date:2017-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty