Healthcare Provider Details

I. General information

NPI: 1578331161
Provider Name (Legal Business Name): ARK INTEGRATIVE MEDICINE AND THERAPEUTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2023
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15785 LAGUNA CANYON RD STE 125
IRVINE CA
92618-3140
US

IV. Provider business mailing address

15785 LAGUNA CANYON RD STE 125
IRVINE CA
92618-3140
US

V. Phone/Fax

Practice location:
  • Phone: 866-542-2865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL GERSHENZON
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 937-838-0568