Healthcare Provider Details

I. General information

NPI: 1952073157
Provider Name (Legal Business Name): CHOICE HEALTH NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S BEACH BLVD STE 111
ANAHEIM CA
92804-1866
US

IV. Provider business mailing address

408 S BEACH BLVD STE 111
ANAHEIM CA
92804-1866
US

V. Phone/Fax

Practice location:
  • Phone: 714-826-8800
  • Fax:
Mailing address:
  • Phone: 714-826-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN EBILANE
Title or Position: CEO
Credential:
Phone: 714-826-8800