Healthcare Provider Details

I. General information

NPI: 1699658393
Provider Name (Legal Business Name): TIMOTHY EUJIN GALLAGHER SUDRC II #22514
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2025
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 W MACARTHUR BLVD STE 201
SANTA ANA CA
92704-6972
US

IV. Provider business mailing address

14371 WEBBER PL
WESTMINSTER CA
92683-4308
US

V. Phone/Fax

Practice location:
  • Phone: 949-875-0807
  • Fax:
Mailing address:
  • Phone: 657-688-2111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: