Provider Demographics
NPI:1619607116
Name:ORANGE OAK PSYCHIATRY
Entity Type:Organization
Organization Name:ORANGE OAK PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:OXANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGOUT
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:714-343-3909
Mailing Address - Street 1:300 SPECTRUM CENTER DR # 465
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 SPECTRUM CENTER DR # 465
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4925
Practice Address - Country:US
Practice Address - Phone:714-343-3909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477910214Medicaid