Provider Demographics
NPI:1356472344
Name:PAUL J. CIMOCH II, MD, A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:PAUL J. CIMOCH II, MD, A PROFESSIONAL CORP
Other - Org Name:CENTER FOR SPECIAL IMMUNOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CIMOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-206-6868
Mailing Address - Street 1:1503 S COAST DR
Mailing Address - Street 2:SUITE 111
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-1534
Mailing Address - Country:US
Mailing Address - Phone:714-206-6868
Mailing Address - Fax:714-429-1685
Practice Address - Street 1:1503 S COAST DR
Practice Address - Street 2:SUITE 111
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-1534
Practice Address - Country:US
Practice Address - Phone:714-206-6868
Practice Address - Fax:714-429-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA546088207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0066170Medicaid
CAW14601Medicare PIN