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General NPI Number Information
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NPI Number | 1649186412
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Entity Type | Organization
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Legal Business Name | JOVIVE WOUND CARE PC
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Dates
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Enumeration Date | 08/21/2026
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Last Update Date | 08/21/2026
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Provider Practice Location Address
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Address Line | 11340 MOUNTAIN VIEW AVE STE B
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City | LOMA LINDA
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State | CA
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Zip | 92354-3858
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Country | US
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Telephone | 909-435-4852
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Fax |
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Provider Business Mailing Address
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Address Line | 2100 POWELL ST STE 400
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City | EMERYVILLE
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State | CA
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Zip | 94608-1872
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THEOPHILE GEORGE KOURY
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Credential | MD
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Telephone | 510-350-2774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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