Healthcare Provider Details

I. General information

NPI: 1649486127
Provider Name (Legal Business Name): JENS W. DIMMICK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N MAIN ST 400
SANTA ANA CA
92705-6634
US

IV. Provider business mailing address

2700 N MAIN ST SUITE 400
SANTA ANA CA
92705-6634
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-1555
  • Fax: 714-834-0780
Mailing address:
  • Phone: 714-834-1555
  • Fax: 714-834-0780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberG26557
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JENS W DIMMICK
Title or Position: OWNER
Credential: M.D.
Phone: 714-834-1555