Healthcare Provider Details

I. General information

NPI: 1902280019
Provider Name (Legal Business Name): BACH MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2015
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17672 COWAN
IRVINE CA
92614-6027
US

IV. Provider business mailing address

17672 COWAN
IRVINE CA
92614-6027
US

V. Phone/Fax

Practice location:
  • Phone: 800-544-4181
  • Fax: 949-236-6646
Mailing address:
  • Phone: 800-544-4181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DYLAN BACH
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 714-273-4991