Healthcare Provider Details

I. General information

NPI: 1811192081
Provider Name (Legal Business Name): UNIVERSAL INTEGRATED HEALTH MEDICAL GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 BIRCH ST., SUITE 200
NEWPORT BEACH CA
92660
US

IV. Provider business mailing address

4100 BIRCH ST., SUITE 200
NEWPORT BEACH CA
92660
US

V. Phone/Fax

Practice location:
  • Phone: 949-417-0420
  • Fax: 877-631-2676
Mailing address:
  • Phone: 949-417-0420
  • Fax: 877-631-2676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberA40490
License Number StateCA

VIII. Authorized Official

Name: KAMER MIGIRDICHIAN
Title or Position: CEO
Credential:
Phone: 949-417-0420