Provider Demographics
NPI:1861637571
Name:AVICURE, INC
Entity Type:Organization
Organization Name:AVICURE, INC
Other - Org Name:ANESIS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KWON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-308-4206
Mailing Address - Street 1:1201 S BEACH BLVD STE 104B
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-6366
Mailing Address - Country:US
Mailing Address - Phone:714-253-3021
Mailing Address - Fax:
Practice Address - Street 1:1201 S BEACH BLVD STE 104B
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-6366
Practice Address - Country:US
Practice Address - Phone:714-253-3021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52804261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care