Organization
NEUROLOGICAL MEDICAL GROUP OF ORANGE COUNTY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES J PARK D.O (PRESIDENT)
(714) 636-7844
Entity
Organization
Contact information
Practice address
12555 GARDEN GROVE BLVD, SUITE 305, GARDEN GROVE, CA 92843-1902
(714) 636-7844
(714) 847-7396
Mailing address
11 FLORA SPGS, IRVINE, CA 92602-2412
(714) 847-7392
(714) 847-7396
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
20A7365
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00AX73650
MEDI-CAL I.D NUMBER
CA
01
—
1306871421
INDIVIDUAL NPI NUMBER
CA
01
—
W20108
MEDICARE GROUP ID
CA
01
—
ZZZ04904Z
BLUE SHIELD ID
CA
Enumeration date
07/22/2006
Last updated
07/26/2007
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