Provider Demographics
NPI:1356767867
Name:HOLLYWOOD URGENT CARE
Entity type:Organization
Organization Name:HOLLYWOOD URGENT CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
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 1:5717 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-3807
Mailing Address - Country:US
Mailing Address - Phone:323-957-2273
Mailing Address - Fax:323-957-2274
Practice Address - Street 1:5717 MELROSE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-3807
Practice Address - Country:US
Practice Address - Phone:323-957-2273
Practice Address - Fax:323-957-2274
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANAHEIM URGENT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75850261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care