Healthcare Provider Details

I. General information

NPI: 1265709414
Provider Name (Legal Business Name): ORANGE COUNTY HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9918 KATELLA AVE STE C
ANAHEIM CA
92804-6465
US

IV. Provider business mailing address

9918 KATELLA AVE STE C
ANAHEIM CA
92804-6466
US

V. Phone/Fax

Practice location:
  • Phone: 714-625-8320
  • Fax: 714-583-7660
Mailing address:
  • Phone: 714-625-8320
  • Fax: 657-999-6396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: SUHEIR KILANI
Title or Position: PRESIDENT
Credential: PA
Phone: 714-625-8320