Provider Demographics
NPI:1053458828
Name:DOCTORS OF OBGYN MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DOCTORS OF OBGYN MEDICAL CORPORATION
Other - Org Name:NO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-848-2383
Mailing Address - Street 1:8700 WARNER AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-3207
Mailing Address - Country:US
Mailing Address - Phone:714-848-2383
Mailing Address - Fax:714-848-4083
Practice Address - Street 1:8700 WARNER AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-3207
Practice Address - Country:US
Practice Address - Phone:714-848-2383
Practice Address - Fax:714-848-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83581207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G835810Medicaid
CA1225187388OtherNPI INDIVIDUAL #
CA1053458828OtherGROUP NPI
CAW15938Medicare PIN