1841591849 NPI number — NEWPORT BEACH ENDOCRINE MEDICAL GROUP INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841591849 NPI number — NEWPORT BEACH ENDOCRINE MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWPORT BEACH ENDOCRINE MEDICAL GROUP 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:
1841591849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1339
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92659-0039
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-836-5612
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 SUPERIOR AVE
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-3637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-836-5612
Provider Business Practice Location Address Fax Number:
949-642-7703
Provider Enumeration Date:
11/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
IYER
Authorized Official First Name:
KRIS
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-836-5612

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A40933 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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