MEDICARE: ORANGE COUNTY GASTROENTEROLOGICAL MEDICAL GROUP INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	G13929	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770632234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORANGE COUNTY GASTROENTEROLOGICAL MEDICAL GROUP INCORPORATED

Provider Business Mailing Address
First Line	:	3055 W ORANGE AVE STE 105
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3152
Country	:	US
Telephone Number	:	714-995-4704
Fax Number	:	714-995-3814

Provider Business Practice Location Address
First Line	:	3055 W ORANGE AVE STE 105
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92804-3152
Country	:	US
Telephone Number	:	714-995-4704
Fax Number	:	714-995-3814

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENNETH M YAMASHIRO
Credential	:	MD
Telephone Number	:	714-995-4704

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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