Provider Demographics
NPI:1780843458
Name:DIGESTIVE DISEASE CONSULTANTS OF ORANGE COUNTY INC
Entity Type:Organization
Organization Name:DIGESTIVE DISEASE CONSULTANTS OF ORANGE COUNTY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-612-9090
Mailing Address - Street 1:PO BOX 53366
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92619-3366
Mailing Address - Country:US
Mailing Address - Phone:949-612-9090
Mailing Address - Fax:949-612-9091
Practice Address - Street 1:113 WATERWORKS WAY
Practice Address - Street 2:SUITE 155
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3167
Practice Address - Country:US
Practice Address - Phone:949-612-9090
Practice Address - Fax:949-612-9091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79889207RG0100X
2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB836611OtherKAISER NATIONAL USER ID
CABK894Medicare PIN