Provider Demographics
NPI:1821014259
Name:OCEAN PACIFIC MEDICAL CORPORATION
Entity Type:Organization
Organization Name:OCEAN PACIFIC MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:K
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-218-5959
Mailing Address - Street 1:67 S PEAK
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2903
Mailing Address - Country:US
Mailing Address - Phone:949-218-5959
Mailing Address - Fax:949-218-4949
Practice Address - Street 1:31852 COAST HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-6764
Practice Address - Country:US
Practice Address - Phone:949-218-5959
Practice Address - Fax:949-218-4949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAFNP32699207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty