Provider Demographics
NPI:1346777505
Name:KABO HEALTH LLC
Entity Type:Organization
Organization Name:KABO HEALTH LLC
Other - Org Name:MOUNTAIN VIEW URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:VANRAVENSWAAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-766-1049
Mailing Address - Street 1:3521 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-1111
Mailing Address - Country:US
Mailing Address - Phone:805-766-1049
Mailing Address - Fax:907-868-1105
Practice Address - Street 1:3521 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-1111
Practice Address - Country:US
Practice Address - Phone:805-766-1049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-18
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK111160207Q00000X, 261QU0200X
AK1048438261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty