MEDICARE: PRIMARY AND MULTI-SPECIALTY CLINICS OF ANAHEIM, INC

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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1861907024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY AND MULTI-SPECIALTY CLINICS OF ANAHEIM, INC

Provider Business Mailing Address
First Line	:	710 N EUCLID ST # 400
Second Line	:
City	:	ANAHEIM
State	:	CA
Zip	:	92801-4122
Country	:	US
Telephone Number	:	714-300-0477
Fax Number	:	714-300-0473

Provider Business Practice Location Address
First Line	:	801 N TUSTIN AVE STE 602
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92705-3610
Country	:	US
Telephone Number	:	714-517-2000
Fax Number	:	714-490-1975

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MITCHELL W. LEW
Credential	:	MD
Telephone Number	:	714-517-2000

Provider Enumeration Date	:	12/11/2017
Last Update Date	:	01/24/2023

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