Healthcare Provider Details

I. General information

NPI: 1811564479
Provider Name (Legal Business Name): ASCADA HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W BASTANCHURY RD STE 220
FULLERTON CA
92835-3424
US

IV. Provider business mailing address

301 W BASTANCHURY RD STE 220
FULLERTON CA
92835-3424
US

V. Phone/Fax

Practice location:
  • Phone: 657-230-7337
  • Fax: 657-272-7720
Mailing address:
  • Phone: 657-230-7337
  • Fax: 657-272-7720

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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN OEI
Title or Position: OWNER
Credential:
Phone: 657-295-1333