Medical Youth Fountain Incorporated

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

MEDICAL YOUTH FOUNTAIN INCORPORATED

Practice address

557 N Central Ave
Upland, CA 91786-4241

Phone

(909) 608-7178

Fax

(909) 608-0939

NPI assigned

May 12, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Farabi Mohamed Hussain, MDNPI 1104866748

Title

Ceo

Phone

(909) 608-7178

Specialties & licenses 1

Addresses

Other names 1

• ABC Surgery Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Farabi M. Hussain, MD

  • Surgery Physician
  • Colton, CA
  • NPI 1104866748
  Medicare reassignment NPD Authorized official
• Kasein Gonzalez, MD

  • Family Medicine Physician
  • Orange, CA
  • NPI 1700049459
  NPD

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

{
    "created_epoch": "1683849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1366132243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "557 N CENTRAL AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864241",
            "telephone_number": "909-608-7178",
            "fax_number": "909-608-0939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "557 N CENTRAL AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917864241",
            "telephone_number": "909-608-7178",
            "fax_number": "909-608-0939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL YOUTH FOUNTAIN INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-12",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "HUSSAIN",
        "authorized_official_first_name": "FARABI",
        "authorized_official_middle_name": "MOHAMED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "909-608-7178",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ABC Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Medical Logistics
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• Gerardo Antonio Medina
• Medinova Inc
• Medinova Inc
• Medix Healthcare, Inc

• Surgery Physician in Upland, CA
• Providers in Upland, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.