Wadie Alkhouri MD Inc

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

License

C51885 Issued in CA

Legal business name

WADIE ALKHOURI MD INC

Practice address

210 S. Grand Ave
Suite 320
Glendora, CA 91741-4286

Phone

(626) 335-1919

Fax

(626) 335-1911

NPI assigned

Jul 12, 2013

Last updated

Jul 14, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Wadie Alkhouri, MD

Title

Owner/President/Ceo

Phone

(626) 335-1919

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1468454400000",
    "number": "1144661653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S. GRAND AVE",
            "address_2": "SUITE 320",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414286",
            "telephone_number": "626-335-1919",
            "fax_number": "626-335-1911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S. GRAND AVE",
            "address_2": "SUITE 320",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917414286",
            "telephone_number": "626-335-1919",
            "fax_number": "626-335-1911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WADIE ALKHOURI MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-12",
        "last_updated": "2016-07-14",
        "status": "A",
        "authorized_official_last_name": "ALKHOURI",
        "authorized_official_first_name": "WADIE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT/CEO",
        "authorized_official_telephone_number": "626-335-1919",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": "CA",
            "license": "C51885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000518850",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TYPE 1 NPI",
            "identifier": "1568556652",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Exclusive Provider Organization in Glendora, CA
• Providers in Glendora, CA by specialty
• Exclusive Provider Organization in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2016; 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.