Provider Demographics
NPI:1013083724
Name:BIOPSYCHOSOCIAL MEDICAL OFFICE, INC.
Entity Type:Organization
Organization Name:BIOPSYCHOSOCIAL MEDICAL OFFICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:H
Authorized Official - Last Name:ARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-451-1789
Mailing Address - Street 1:62 DISCOVERY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3142
Mailing Address - Country:US
Mailing Address - Phone:949-451-1789
Mailing Address - Fax:949-451-1431
Practice Address - Street 1:62 DISCOVERY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3142
Practice Address - Country:US
Practice Address - Phone:949-451-1789
Practice Address - Fax:949-451-1431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA722312084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID
WA72231BMedicare ID - Type Unspecified
=========OtherTAX ID