Healthcare Provider Details

I. General information

NPI: 1699369561
Provider Name (Legal Business Name): SICK CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2507 EASTBLUFF DR STE C
NEWPORT BEACH CA
92660-3504
US

IV. Provider business mailing address

2507 EASTBLUFF DR STE C
NEWPORT BEACH CA
92660-3504
US

V. Phone/Fax

Practice location:
  • Phone: 888-544-9262
  • Fax: 949-264-9028
Mailing address:
  • Phone: 888-544-9262
  • Fax: 949-264-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL HSU
Title or Position: CFO
Credential:
Phone: 562-244-1959