Yacoub Medical Inc.

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

A40189 Issued in CA

Legal business name

YACOUB MEDICAL INC.

Practice address

120 S Montebello Blvd
Montebello, CA 90640-4730

Phone

(323) 726-0577

NPI assigned

Jun 11, 2013

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenny Heine

Title

VP of Operations

Phone

(858) 964-1506

Specialties & licenses 1

Addresses

Other names 1

• Doctors Urgent Care Doing business as

Tax ID family

Atef L Yacoub MD3 organizations share this tax ID, including this one

Part of

Tri - State Medical Group Inc

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Yacoub Medical, Inc.

  • Clinical Medical Laboratory
  • Montebello, CA
  • NPI 1154508497
  NPD tax ID
• Yacoub Medical, Inc.

  • General Practice Physician
  • Montebello, CA
  • NPI 1477698512
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1370908800000",
    "number": "1114365210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S MONTEBELLO BLVD",
            "city": "MONTEBELLO",
            "state": "CA",
            "postal_code": "906404730",
            "telephone_number": "323-726-0577"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YACOUB MEDICAL INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2013-06-11",
        "last_updated": "2013-06-11",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-964-1506"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A40189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doctors Urgent Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Christina Woodson
• Charles B. Worley, PA-C
• Ruth S Wu, D.D.S.
• Wuu Shyong Wu M.D.
• XCB Holdings, Inc.
• Yacoub Medical, Inc.
• Yacoub Medical, Inc.
• Atef Labib Yacoub, M.D.
• Vahid Yahoodain, D.D.S
• Bao Bin Yang, MD

• Non-Pharmacy Dispensing Site in Montebello, CA
• Providers in Montebello, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.