Healthcare Provider Details

I. General information

NPI: 1437409653
Provider Name (Legal Business Name): SANTA MONICA URGENT CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2012
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 COLORADO AVE
SANTA MONICA CA
90401-2408
US

IV. Provider business mailing address

524 COLORADO AVE
SANTA MONICA CA
90401-2408
US

V. Phone/Fax

Practice location:
  • Phone: 310-394-2273
  • Fax:
Mailing address:
  • Phone: 310-394-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. MORRIS KOKHAB
Title or Position: MANAGER
Credential: M.D.
Phone: 310-945-6070