Provider Demographics
NPI:1659416659
Name:SUNSET URGENT CARE MEDICAL CENTER
Entity Type:Organization
Organization Name:SUNSET URGENT CARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ISIDORE
Authorized Official - Middle Name:
Authorized Official - Last Name:KWAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-271-2744
Mailing Address - Street 1:PO BOX 5280
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92615-5280
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9201 SUNSET BLVD 705
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90069-3701
Practice Address - Country:US
Practice Address - Phone:310-271-2744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF24902Medicare UPIN
CAW14891Medicare ID - Type UnspecifiedNHIC MEDICARE