Provider Demographics
NPI:1609325588
Name:IRVINE VILLAGE URGENT CARE
Entity Type:Organization
Organization Name:IRVINE VILLAGE URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DZUNG
Authorized Official - Middle Name:A
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-654-8455
Mailing Address - Street 1:15435 JEFFREY ROAD #127
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:949-654-8455
Mailing Address - Fax:
Practice Address - Street 1:15435 JEFFREY RD STE 127
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4113
Practice Address - Country:US
Practice Address - Phone:949-654-8455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6269261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
F74892Medicare UPIN