| Optimum Medical Clinics Inc | |
|
20072 Sw Birch St Ste 100 Newport Beach CA 92660-0794 | |
| (949) 757-1150 | |
| (949) 757-1170 |
| Full Name | Optimum Medical Clinics Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 20072 Sw Birch St, Newport Beach, California |
| Authorized Official Name and Position | Samuel Kyung-uk Park (MEDICAL DIRECTOR) |
| Authorized Official Contact | 9497571150 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Optimum Medical Clinics Inc 20072 Sw Birch St Ste 100 Newport Beach CA 92660-0794 Ph: (949) 757-1150 | Optimum Medical Clinics Inc 20072 Sw Birch St Ste 100 Newport Beach CA 92660-0794 Ph: (949) 757-1150 |
| NPI Number | 1649354366 |
|---|---|
| Provider Enumeration Date | 10/25/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4880622158 |
|---|---|
| Medicare Enrollment ID | O20050728000242 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649354366 | NPI | - | NPPES |
| GR0088240 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A050474 (California) | Primary |
| Provider Name | Ellen T Song |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528079589 PECOS PAC ID: 4789650797 Enrollment ID: I20040909000910 |
| Provider Name | Alejandro Gonzalez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1538108097 PECOS PAC ID: 9830007152 Enrollment ID: I20080229000534 |
| Provider Name | Samuel K Park |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497832661 PECOS PAC ID: 9133157407 Enrollment ID: I20120504000528 |
| Provider Name | Parth P Patel |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1194086595 PECOS PAC ID: 3274781174 Enrollment ID: I20120919000112 |
| Provider Name | Ryan Andrew Fan |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1720052459 PECOS PAC ID: 2961621891 Enrollment ID: I20141024000639 |
| Provider Name | Sahar Lashin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1598053894 PECOS PAC ID: 9739404658 Enrollment ID: I20150217000140 |
| Provider Name | Damien J Burgess |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699917138 PECOS PAC ID: 3173750791 Enrollment ID: I20200709003473 |
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