Provider Demographics
NPI:1609145127
Name:SPINE AND PAIN INSTITUTE OF ORANGE COUNTY, INC.
Entity Type:Organization
Organization Name:SPINE AND PAIN INSTITUTE OF ORANGE COUNTY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHUANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-340-9622
Mailing Address - Street 1:PO BOX 5099
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-5099
Mailing Address - Country:US
Mailing Address - Phone:714-571-5000
Mailing Address - Fax:714-571-5055
Practice Address - Street 1:113 WATERWORKS WAY
Practice Address - Street 2:SUITE 240
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3167
Practice Address - Country:US
Practice Address - Phone:949-340-9622
Practice Address - Fax:949-528-3969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-29
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 207X00000X, 207XS0117X, 208100000X, 208VP0000X
CAG87832207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty