Healthcare Provider Details

I. General information

NPI: 1881653467
Provider Name (Legal Business Name): GREGORY H. WOLF M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2617 E CHAPMAN AVE #204
ORANGE CA
92869-3226
US

IV. Provider business mailing address

2617 E CHAPMAN AVE #204
ORANGE CA
92869-3226
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-4040
  • Fax: 714-633-1432
Mailing address:
  • Phone: 714-633-4040
  • Fax: 714-633-1432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG050845
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG050845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: