| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 07/26/2007 |
| Medicare PECOS PAC ID | 1153328042 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1306871421 PECOS PAC ID: 7911987912 Enrollment ID: I20040721000794 |
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