Provider Demographics
NPI:1366463358
Name:NEUROLOGICAL MEDICAL GROUP OF ORANGE COUNTY INC
Entity Type:Organization
Organization Name:NEUROLOGICAL MEDICAL GROUP OF ORANGE COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-636-7844
Mailing Address - Street 1:11 FLORA SPGS
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2412
Mailing Address - Country:US
Mailing Address - Phone:714-847-7392
Mailing Address - Fax:714-847-7396
Practice Address - Street 1:12555 GARDEN GROVE BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1902
Practice Address - Country:US
Practice Address - Phone:714-636-7844
Practice Address - Fax:714-847-7396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A73652084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX73650OtherMEDI-CAL I.D NUMBER
CA1306871421OtherINDIVIDUAL NPI NUMBER
CAZZZ04904ZOtherBLUE SHIELD ID
CAW20108OtherMEDICARE GROUP ID
CA1306871421OtherINDIVIDUAL NPI NUMBER
CAW20108OtherMEDICARE GROUP ID