Neurological Medical Group Of Orange County Inc | |
12555 Garden Grove Blvd Suite 305 Garden Grove CA 92843-1902 | |
(714) 636-7844 | |
(714) 847-7396 |
Full Name | Neurological Medical Group Of Orange County Inc |
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Speciality | Psychiatry & Neurology |
Location | 12555 Garden Grove Blvd, Garden Grove, California |
Authorized Official Name and Position | James J Park (PRESIDENT) |
Authorized Official Contact | 7146367844 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Neurological Medical Group Of Orange County Inc 11 Flora Spgs Irvine CA 92602-2412 Ph: (714) 847-7392 | Neurological Medical Group Of Orange County Inc 12555 Garden Grove Blvd Suite 305 Garden Grove CA 92843-1902 Ph: (714) 636-7844 |
NPI Number | 1366463358 |
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Provider Enumeration Date | 07/22/2006 |
Last Update Date | 07/26/2007 |
Medicare PECOS PAC ID | 1153328042 |
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Medicare Enrollment ID | O20061107000495 |
Identifier | Type | State | Issuer |
---|---|---|---|
1366463358 | NPI | - | NPPES |
00AX73650 | Other | CA | MEDI-CAL I.D NUMBER |
1306871421 | Other | CA | INDIVIDUAL NPI NUMBER |
ZZZ04904Z | Other | CA | BLUE SHIELD ID |
W20108 | Other | CA | MEDICARE GROUP ID |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
2084N0400X | Psychiatry & Neurology - Neurology | 20A7365 (California) | Primary |
Provider Name | James J Park |
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Provider Type | Practitioner - Neurology |
Provider Identifiers | NPI Number: 1306871421 PECOS PAC ID: 7911987912 Enrollment ID: I20040721000794 |
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