Provider Demographics
NPI:1831851997
Name:MCGILL, PAUL IN CHUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:IN CHUL
Last Name:MCGILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:594 TRAVERSE DR
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-3117
Mailing Address - Country:US
Mailing Address - Phone:714-616-4375
Mailing Address - Fax:
Practice Address - Street 1:501 N CRESCENT WAY
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-5401
Practice Address - Country:US
Practice Address - Phone:714-999-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist