Provider Demographics
NPI:1720378300
Name:ENCINO MEDICAL URGENT CARE INC.
Entity Type:Organization
Organization Name:ENCINO MEDICAL URGENT CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:YAHYA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEDVAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-881-8117
Mailing Address - Street 1:18055 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3517
Mailing Address - Country:US
Mailing Address - Phone:818-881-8117
Mailing Address - Fax:818-996-8972
Practice Address - Street 1:18055 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3517
Practice Address - Country:US
Practice Address - Phone:818-881-8117
Practice Address - Fax:818-996-8972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1306830021Medicaid