Organization
FOREFRONT-KHATKHATE MEDICAL SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHERRY KOVACS (ASSISTANT/PROVIDER ENROLLMENT)
(949) 552-5232
Entity
Organization
Contact information
Practice address
600 S 2ND ST STE 404, SPRINGFIELD, IL 62704-2542
(510) 201-0190
Mailing address
6201 OAK CYN STE 150, IRVINE, CA 92618-5230
(949) 552-5232
(888) 972-2903
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036-119096
STATE MEDICAL LICENSE
IL
Enumeration date
08/01/2019
Last updated
08/10/2019
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