Provider Demographics
NPI:1679870265
Name:ORANGE COAST FAMILY MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:ORANGE COAST FAMILY MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:949-333-2999
Mailing Address - Street 1:15785 LAGUNA CANYON RD
Mailing Address - Street 2:SUITE 390
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3165
Mailing Address - Country:US
Mailing Address - Phone:949-333-2999
Mailing Address - Fax:949-387-2002
Practice Address - Street 1:15785 LAGUNA CANYON RD
Practice Address - Street 2:SUITE 390
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3165
Practice Address - Country:US
Practice Address - Phone:949-333-2999
Practice Address - Fax:949-387-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-17
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty