Provider Demographics
NPI:1437494606
Name:UC IRVINE MEDICAL CENTER - FOR OC KIDS
Entity Type:Organization
Organization Name:UC IRVINE MEDICAL CENTER - FOR OC KIDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HEYDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-456-2986
Mailing Address - Street 1:1915 W ORANGEWOOD AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-2047
Mailing Address - Country:US
Mailing Address - Phone:714-939-6118
Mailing Address - Fax:714-939-7569
Practice Address - Street 1:1915 W ORANGEWOOD AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2047
Practice Address - Country:US
Practice Address - Phone:714-939-6118
Practice Address - Fax:714-939-7569
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF CALIFORNIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000148261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health