Healthcare Provider Details

I. General information

NPI: 1609719285
Provider Name (Legal Business Name): CIVITAS MED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2026
Last Update Date: 04/10/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18111 BROOKHURST ST
FOUNTAIN VALLEY CA
92708-6728
US

IV. Provider business mailing address

6230 IRVINE BLVD # 338
IRVINE CA
92620-2103
US

V. Phone/Fax

Practice location:
  • Phone: 657-231-8294
  • Fax:
Mailing address:
  • Phone: 657-231-8294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KIM-ORDEN
Title or Position: OWNER
Credential: MD
Phone: 657-231-8294