1225522006 NPI number — ONE PHYSICIANS PC

Table of content: (NPI 1225522006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225522006 NPI number — ONE PHYSICIANS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ONE PHYSICIANS PC
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:
1225522006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 SHELDON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL SEGUNDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90245-3915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-322-4278
Provider Business Mailing Address Fax Number:
310-322-6660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16405 SAND CANYON AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618-3786
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-383-4190
Provider Business Practice Location Address Fax Number:
310-383-4189
Provider Enumeration Date:
06/15/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OZGUR
Authorized Official First Name:
BURAK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
949-383-4190

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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