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General NPI Number Information
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NPI Number | 1649354366
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Entity Type | Organization
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Legal Business Name | OPTIMUM MEDICAL CLINICS INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20072 SW BIRCH ST STE 100
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-0794
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Country | US
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Telephone | 949-757-1150
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Fax | 949-757-1170
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Provider Business Mailing Address
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Address Line | 20072 SW BIRCH ST STE 100
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-0794
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Country | US
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Telephone | 949-757-1150
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Fax | 949-757-1170
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. SAMUEL KYUNG-UK PARK
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Credential | MD
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Telephone | 949-757-1150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A050474
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License Number State | CA
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