Provider Demographics
NPI:1649354366
Name:OPTIMUM MEDICAL CLINICS INC
Entity type:Organization
Organization Name:OPTIMUM MEDICAL CLINICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:KYUNG-UK
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-757-1150
Mailing Address - Street 1:20072 SW BIRCH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0794
Mailing Address - Country:US
Mailing Address - Phone:949-757-1150
Mailing Address - Fax:949-757-1170
Practice Address - Street 1:20072 SW BIRCH ST
Practice Address - Street 2:STE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0794
Practice Address - Country:US
Practice Address - Phone:949-757-1150
Practice Address - Fax:949-757-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA050474207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0088240Medicaid
F87232Medicare UPIN
CAWA50474CMedicare ID - Type Unspecified