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General NPI Number Information
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NPI Number | 1609719285
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Entity Type | Organization
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Legal Business Name | CIVITAS MED
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 18111 BROOKHURST ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6728
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Country | US
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Telephone | 657-231-8294
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Fax |
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Provider Business Mailing Address
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Address Line | 6230 IRVINE BLVD # 338
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City | IRVINE
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State | CA
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Zip | 92620-2103
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Country | US
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Telephone | 657-231-8294
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL KIM-ORDEN
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Credential | MD
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Telephone | 657-231-8294
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number |
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License Number State |
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