Provider Demographics
NPI:1114957669
Name:JK SUNVALLEY HEALTHCARE & ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:JK SUNVALLEY HEALTHCARE & ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KHADIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-547-9552
Mailing Address - Street 1:1413 TAMARACK DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-9251
Mailing Address - Country:US
Mailing Address - Phone:956-547-9552
Mailing Address - Fax:956-574-9425
Practice Address - Street 1:295 W HWY 77, SUITE B
Practice Address - Street 2:
Practice Address - City:SAN BENITO
Practice Address - State:TX
Practice Address - Zip Code:78586
Practice Address - Country:US
Practice Address - Phone:956-547-9552
Practice Address - Fax:956-574-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN00247YMedicare ID - Type Unspecified