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General NPI Number Information
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NPI Number | 1578331161
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Entity Type | Organization
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Legal Business Name | ARK INTEGRATIVE MEDICINE AND THERAPEUTICS PC
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 15785 LAGUNA CANYON RD STE 125
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City | IRVINE
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State | CA
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Zip | 92618-3140
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Country | US
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Telephone | 866-542-2865
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Fax |
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Provider Business Mailing Address
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Address Line | 15785 LAGUNA CANYON RD STE 125
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City | IRVINE
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State | CA
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Zip | 92618-3140
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MICHAEL GERSHENZON
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Credential |
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Telephone | 937-838-0568
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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