Provider Demographics
NPI:1194155945
Name:TIME UNWIND MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:TIME UNWIND MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:C.E.O./OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAIHAN
Authorized Official - Middle Name:U
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-333-3663
Mailing Address - Street 1:PO BOX 54003
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-4003
Mailing Address - Country:US
Mailing Address - Phone:949-333-3663
Mailing Address - Fax:
Practice Address - Street 1:16460 BAKE PKWY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4665
Practice Address - Country:US
Practice Address - Phone:949-333-3663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-14
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86542208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty