Provider Demographics
NPI:1518723857
Name:MARECHEK AND SAGONG SURGERY PARTNERSHIP
Entity Type:Organization
Organization Name:MARECHEK AND SAGONG SURGERY PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARECHEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS
Authorized Official - Phone:858-361-9456
Mailing Address - Street 1:17877 VON KARMAN AVE STE 370
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4201
Mailing Address - Country:US
Mailing Address - Phone:949-818-3223
Mailing Address - Fax:
Practice Address - Street 1:17877 VON KARMAN AVE STE 370
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4201
Practice Address - Country:US
Practice Address - Phone:949-818-3223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty