Healthcare Provider Details

I. General information

NPI: 1003217902
Provider Name (Legal Business Name): NEWPORT CARE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 09/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 E CHAPMAN AVE SUITE 201
ORANGE CA
92869-3226
US

IV. Provider business mailing address

3822 CAMPUS DR SUITE 105
NEWPORT BEACH CA
92660-2627
US

V. Phone/Fax

Practice location:
  • Phone: 949-732-0303
  • Fax: 949-398-5281
Mailing address:
  • Phone: 949-863-9870
  • Fax: 949-863-9873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KASRA ROWSHAN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 949-732-0303