Healthcare Provider Details

I. General information

NPI: 1922038165
Provider Name (Legal Business Name): BIRCH MEDICAL OFFICE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20162 SW BIRCH ST SUITE 150
NEWPORT BEACH CA
92660-0787
US

IV. Provider business mailing address

20162 SW BIRCH ST SUITE 150
NEWPORT BEACH CA
92660-0787
US

V. Phone/Fax

Practice location:
  • Phone: 949-221-1700
  • Fax: 949-221-1704
Mailing address:
  • Phone: 949-221-1700
  • Fax: 949-221-1704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHARON DIANE KANG
Title or Position: BILLING MANAGER
Credential:
Phone: 949-221-1700