1952355315 NPI number — IRVINE INTERNAL MEDICAL GROUP, INC.

Table of content: (NPI 1952355315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952355315 NPI number — IRVINE INTERNAL MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRVINE INTERNAL 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:
1952355315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 575
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUISUN CITY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94585-0575
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
657-241-3600
Provider Business Mailing Address Fax Number:
657-241-7708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 ODYSSEY STE 140
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:
92618-3193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-653-5810
Provider Business Practice Location Address Fax Number:
949-653-1129
Provider Enumeration Date:
05/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIKHAIL
Authorized Official First Name:
EMAD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
949-653-5810

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DH1588 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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