Provider Demographics
NPI:1811192081
Name:UNIVERSAL INTEGRATED HEALTH MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:UNIVERSAL INTEGRATED HEALTH MEDICAL GROUP INC.
Other - Org Name:NEWPORT CREST MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KAMER
Authorized Official - Middle Name:
Authorized Official - Last Name:MIGIRDICHIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-417-0420
Mailing Address - Street 1:4100 BIRCH ST., SUITE 200
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-417-0420
Mailing Address - Fax:877-631-2676
Practice Address - Street 1:4100 BIRCH ST., SUITE 200
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-417-0420
Practice Address - Fax:877-631-2676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40490261QH0100X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty