Provider Demographics
NPI:1841315587
Name:COVINA EMERGENCY MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:COVINA EMERGENCY MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-331-5534
Mailing Address - Street 1:PO BOX 134
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-0134
Mailing Address - Country:US
Mailing Address - Phone:626-331-5534
Mailing Address - Fax:626-967-5506
Practice Address - Street 1:210 W SAN BERNARDINO RD
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1515
Practice Address - Country:US
Practice Address - Phone:626-331-5534
Practice Address - Fax:626-967-5506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0054210Medicaid
CAHW11882Medicare ID - Type UnspecifiedMEDICARE GROUP ID