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General NPI Number Information
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NPI Number | 1679870265
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Entity Type | Organization
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Legal Business Name | ORANGE COAST FAMILY MEDICAL GROUP INC.
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Dates
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Enumeration Date | 02/17/2011
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Last Update Date | 03/16/2011
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Provider Practice Location Address
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Address Line | 15785 LAGUNA CANYON RD SUITE 390
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City | IRVINE
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State | CA
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Zip | 92618-3165
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Country | US
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Telephone | 949-333-2999
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Fax | 949-387-2002
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Provider Business Mailing Address
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Address Line | 15785 LAGUNA CANYON RD SUITE 390
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City | IRVINE
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State | CA
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Zip | 92618-3165
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Country | US
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Telephone | 949-333-2999
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Fax | 949-387-2002
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH WILLIAMS JR.
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Credential | D.O.
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Telephone | 949-333-2999
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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 | 20A5021
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License Number State | CA
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