Healthcare Provider Details

I. General information

NPI: 1912290669
Provider Name (Legal Business Name): ADVANCED URGENT CARE OF BEVERLY HILLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 S ROBERTSON BLVD
BEVERLY HILLS CA
90211-2811
US

IV. Provider business mailing address

242 S ROBERTSON BLVD
BEVERLY HILLS CA
90211-2811
US

V. Phone/Fax

Practice location:
  • Phone: 310-652-2300
  • Fax: 310-652-2320
Mailing address:
  • Phone: 310-652-2300
  • Fax: 310-652-2320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberA75850
License Number StateCA

VIII. Authorized Official

Name: MORRIS KOKHAB
Title or Position: PRESIDENT
Credential: MD
Phone: 310-945-6070