Provider Demographics
NPI:1730808858
Name:COACHELLA VALLEY DIRECT PRIMARY CARE
Entity type:Organization
Organization Name:COACHELLA VALLEY DIRECT PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-642-5549
Mailing Address - Street 1:35400 BOB HOPE DR STE 206
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1774
Mailing Address - Country:US
Mailing Address - Phone:760-642-5549
Mailing Address - Fax:760-507-1008
Practice Address - Street 1:35400 BOB HOPE DR STE 206
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1774
Practice Address - Country:US
Practice Address - Phone:760-642-5549
Practice Address - Fax:760-507-1008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care