Healthcare Provider Details

I. General information

NPI: 1780843458
Provider Name (Legal Business Name): DIGESTIVE DISEASE CONSULTANTS OF ORANGE COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 WATERWORKS WAY SUITE 155
IRVINE CA
92618-3167
US

IV. Provider business mailing address

PO BOX 53366
IRVINE CA
92619-3366
US

V. Phone/Fax

Practice location:
  • Phone: 949-612-9090
  • Fax: 949-612-9091
Mailing address:
  • Phone: 949-612-9090
  • Fax: 949-612-9091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA79889
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL S LEE
Title or Position: OWNER
Credential: MD
Phone: 949-612-9090