Provider Demographics
NPI:1922339092
Name:ADVANCED MEDICAL AND URGENT CARE CENTER
Entity Type:Organization
Organization Name:ADVANCED MEDICAL AND URGENT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MORRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KOKHAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-945-6070
Mailing Address - Street 1:974 W FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3728
Mailing Address - Country:US
Mailing Address - Phone:909-981-2273
Mailing Address - Fax:909-985-2329
Practice Address - Street 1:974 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3728
Practice Address - Country:US
Practice Address - Phone:909-981-2273
Practice Address - Fax:909-985-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-28
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75850261Q00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center