Healthcare Provider Details

I. General information

NPI: 1407609167
Provider Name (Legal Business Name): MIRACLE TOUCH URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 SANTA MONICA BLVD STE 102
LOS ANGELES CA
90029-2654
US

IV. Provider business mailing address

4855 SANTA MONICA BLVD STE 102
LOS ANGELES CA
90029-2654
US

V. Phone/Fax

Practice location:
  • Phone: 323-673-7200
  • Fax: 323-673-7209
Mailing address:
  • Phone: 323-673-7200
  • Fax: 323-673-7209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HOVHANNES KURGHINYAN
Title or Position: PRESIDENT
Credential: MD
Phone: 323-673-7200