Provider Demographics
NPI:1750317228
Name:JK SUN VALLEY HEALTHCARE ASSOCIATES PA
Entity Type:Organization
Organization Name:JK SUN VALLEY HEALTHCARE ASSOCIATES PA
Other - Org Name:JK URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAZIM
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-350-5444
Mailing Address - Street 1:2686 W ALTON GLOOR BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-4055
Mailing Address - Country:US
Mailing Address - Phone:956-350-5444
Mailing Address - Fax:956-350-2493
Practice Address - Street 1:2686 W ALTON GLOOR BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520
Practice Address - Country:US
Practice Address - Phone:956-350-5444
Practice Address - Fax:956-350-2493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208D00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205230001Medicaid
TX0A4579Medicare PIN