Healthcare Provider Details

I. General information

NPI: 1891303400
Provider Name (Legal Business Name): UROLOGY CENTER OF ORANGE COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 DELAWARE ST STE 750
HUNTINGTON BEACH CA
92648-6094
US

IV. Provider business mailing address

18800 DELAWARE ST STE 750
HUNTINGTON BEACH CA
92648-6094
US

V. Phone/Fax

Practice location:
  • Phone: 714-546-1121
  • Fax: 714-546-0428
Mailing address:
  • Phone: 714-546-1121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KHALED FAREED
Title or Position: CEO
Credential: MD
Phone: 714-546-1121