Healthcare Provider Details

I. General information

NPI: 1275737280
Provider Name (Legal Business Name): JOHN ANTHONY KURI II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 BROCKTON AVE SUITE 175
RIVERSIDE CA
92501-4015
US

IV. Provider business mailing address

4510 BROCKTON AVE SUITE 175
RIVERSIDE CA
92501-4015
US

V. Phone/Fax

Practice location:
  • Phone: 951-786-5100
  • Fax: 951-786-5110
Mailing address:
  • Phone: 951-786-5100
  • Fax: 951-786-5110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number247323
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number247323
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number119676
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD432648
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: