1780843458 NPI number — DIGESTIVE DISEASE CONSULTANTS OF ORANGE COUNTY INC

Table of content: (NPI 1780843458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780843458 NPI number — DIGESTIVE DISEASE CONSULTANTS OF ORANGE COUNTY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGESTIVE DISEASE CONSULTANTS OF ORANGE COUNTY INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780843458
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 53366
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92619-3366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-612-9090
Provider Business Mailing Address Fax Number:
949-612-9091

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 WATERWORKS WAY
Provider Second Line Business Practice Location Address:
SUITE 155
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-3167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-612-9090
Provider Business Practice Location Address Fax Number:
949-612-9091
Provider Enumeration Date:
06/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
S
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
949-612-9090

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  A79889 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: B836611 . This is a "KAISER NATIONAL USER ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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