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COASTAL FAMILY MEDICINE INC NPI 1275584120


NPI Information

NPI: 1275584120
Provider Name: COASTAL FAMILY MEDICINE, INC

Doing Business As: FAMILY CARE CENTERS MEDICAL GROUP

Classification: Clinic/Center - 261QM1300X
Entity Type: Organization

Specialization: Multi-Specialty

CLIA Number: 05D0914730

Address:
660 BAKER ST STE A101
COSTA MESA, CA
ZIP 92626
Phone: (714) 668-2500
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COASTAL FAMILY MEDICINE, INC is a multi-specialty clinic center in Costa Mesa, CA. COASTAL FAMILY MEDICINE, INC NPI is 1275584120. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Family Care Centers Medical Group.

The provider's business location address is:

660 BAKER ST STE A101
COSTA MESA, CA
ZIP 92626-407
Phone: (714) 668-2500
Fax: (714) 668-2515

The provider's authorized official is David S Kim .
The authorized official title is President and has the following contact phone number (657) 241-3500.

The CLIA number assigned to this NPI record is 05D0914730 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/15/2006 and was last updated on 2/21/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineCALIFORNIANo
2207QG0300XFamily MedicineGeriatric MedicineNo
3207QS0010XFamily MedicineSports MedicineCALIFORNIANo
4208D00000XGeneral PracticeCALIFORNIANo
5363A00000XPhysician AssistantCALIFORNIANo
6363L00000XNurse PractitionerCALIFORNIANo
7261QM1300XClinic/CenterMulti-SpecialtyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1DE5878OTHERCALIFORNIAMEDICARE RAILROAD

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024
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