Healthcare Provider Details

I. General information

NPI: 1760651129
Provider Name (Legal Business Name): K'IMA: W MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 05/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 AIRPORTROAD
HOOPA CA
95546-1288
US

IV. Provider business mailing address

535 AIRPORT ROAD PO BOX 1288
HOOPA CA
95546-1288
US

V. Phone/Fax

Practice location:
  • Phone: 530-625-4261
  • Fax: 530-625-9308
Mailing address:
  • Phone: 530-625-4261
  • Fax: 530-625-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberEXEMPT INDIAN TRIBE
License Number StateCA

VIII. Authorized Official

Name: MIHAIL SOARE
Title or Position: CLINICAL DIRECTOR/CEO
Credential:
Phone: 530-625-4261