Healthcare Provider Details

I. General information

NPI: 1598067076
Provider Name (Legal Business Name): COMPREHENSIVE CARE CENTER OF IRVINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2010
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E YALE LOOP STE 204
IRVINE CA
92604-4697
US

IV. Provider business mailing address

PO BOX 2768
SUISUN CITY CA
94585-5768
US

V. Phone/Fax

Practice location:
  • Phone: 949-732-3530
  • Fax: 949-732-3533
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. KALENA K HWANG
Title or Position: PRESIDENT
Credential:
Phone: 949-732-3530