Healthcare Provider Details

I. General information

NPI: 1861907024
Provider Name (Legal Business Name): PRIMARY AND MULTI-SPECIALTY CLINICS OF ANAHEIM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2017
Last Update Date: 01/24/2023
Certification Date: 01/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N TUSTIN AVE STE 602
SANTA ANA CA
92705-3610
US

IV. Provider business mailing address

710 N EUCLID ST # 400
ANAHEIM CA
92801-4122
US

V. Phone/Fax

Practice location:
  • Phone: 714-517-2000
  • Fax: 714-490-1975
Mailing address:
  • Phone: 714-300-0477
  • Fax: 714-300-0473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MITCHELL W. LEW
Title or Position: PRESIDENT
Credential: MD
Phone: 714-517-2000