Healthcare Provider Details

I. General information

NPI: 1881666774
Provider Name (Legal Business Name): MIKI T. PURNELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIKI TANAKA MD

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

856 HEALTH SCIENCES RD STE 260
IRVINE CA
92617-3058
US

IV. Provider business mailing address

200 S MANCHESTER AVE STE 300
ORANGE CA
92868-3219
US

V. Phone/Fax

Practice location:
  • Phone: 499-824-7000
  • Fax:
Mailing address:
  • Phone: 714-456-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA80786
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberA80786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: