Healthcare Provider Details

I. General information

NPI: 1649354366
Provider Name (Legal Business Name): OPTIMUM MEDICAL CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20072 SW BIRCH ST STE 100
NEWPORT BEACH CA
92660-0794
US

IV. Provider business mailing address

20072 SW BIRCH ST STE 100
NEWPORT BEACH CA
92660-0794
US

V. Phone/Fax

Practice location:
  • Phone: 949-757-1150
  • Fax: 949-757-1170
Mailing address:
  • Phone: 949-757-1150
  • Fax: 949-757-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA050474
License Number StateCA

VIII. Authorized Official

Name: DR. SAMUEL KYUNG-UK PARK
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 949-757-1150