# INJURED WORKERS MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1124630967
- **Authorized official:** DR. VRIJESH SHANTANU TANTUWAYA MD (PRESIDENT)
- **Authorized official phone:** (858) 472-1380

## Contact information

- **Practice address:** 4600 CAMPUS DR STE 108, NEWPORT BEACH, CA 92660-1885
- **Practice address phone:** (949) 769-6071
- **Mailing address:** 14252 CULVER DR STE 295, IRVINE, CA 92604-0317

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111NX0100X | Occupational Health Chiropractor | — | NULL | — |
| 111NX0100X | Occupational Health Chiropractor | — | — | — |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 261QX0100X | Occupational Medicine Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 08/22/2020
- **Last updated:** 08/22/2020