TUSTIN IRVINE INTERNAL MEDICINE GROUP INC. (NPI# 1689633125) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689633125 |
| Entity Type | Organization |
| Organization Name | TUSTIN IRVINE INTERNAL MEDICINE GROUP INC. |
| Practice Address |
17400 Irvine Blvd Suite F Tustin CA 92780-3030 |
| Practice Telephone | 7148385610 |
| Practice Fax Number | 7148385931 |
| Mailing Telephone | 7148385610 |
| Mailing Fax Number | 7148385931 |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2011-06-10 |
| Authorized Official Name | MR. MARIO S FICAROLA (PRESIDENT) |
| Authorized Official Telephone | 7148385610 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | YYY 42455 Y | 05 | |
| CA | BLUE SHIELD | YYY 42455 Y | 01 |
| CA | NPI | 1962544494 | 01 |
| Street Address |
17400 IRVINE BLVD SUITE F |
| City | TUSTIN |
| State | CA |
| Zip Code | 92780-3030 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033592241 | Nevein Elgalad D.d.s. Inc | Dentist | 17400 Irvine Blvd, Suite D, Tustin, CA 92780-3030 | 2015-07-07 |
| 1346499118 | James Paul Boyd | Dentist | 17400 Irvine Blvd, Suite D, Tustin, CA 92780-3030 | 2008-09-16 |
| 1952557878 | Dr Charles Baik Inc | Podiatrist | 17400 Irvine Blvd, Suite H, Tustin, CA 92780-3030 | 2008-08-12 |
| 1396929774 | Orange County Foot & Ankle Group, Inc. | Podiatrist | 17400 Irvine Blvd, Suite J, Tustin, CA 92780-3030 | 2007-12-21 |
| 1174716591 | Kerrie Imagawa | Dentist | 17400 Irvine Blvd, Ste C, Tustin, CA 92780 | 2007-08-20 |
| 1962525063 | Nancy Mostaan | Dentist | 17400 Irvine Blvd, Suite A, Tustin, CA 92780 | 2007-04-06 |
| 1336284314 | Klemer Chiropractic Office A Professional Corporation | Chiropractor | 17400 Irvine Blvd, Suite L, Tustin, CA 92780-3030 | 2007-02-20 |
| 1659416741 | Jack Oscar Piasecki | Neuromusculoskeletal Medicine, Sports Medicine | 17400 Irvine Blvd, Suite L, Tustin, CA 92780-3030 | 2007-02-20 |
| 1962544494 | Julia Collins Motherway | Internal Medicine | 17400 Irvine Blvd, Suite F, Tustin, CA 92780-3030 | 2007-02-12 |
| 1285780338 | Christine Switzer Burnell | Speech-Language Pathologist | 17400 Irvine Blvd, Suite K, Tustin, CA 92780-3030 | 2007-01-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437780947 | John Michael Michael | Pharmacist | 14481 Wildeve Ln, Tustin, CA 92780 | 2020-02-03 |
| 1609426881 | Abigail Joy Maqsood | Behavior Technician | 290a S Prospect Ave, Tustin, CA 92780 | 2019-09-19 |
| 1255814711 | Hyun Dong Lee | Chiropractor | 14591 Newport Ave Ste 106, Tustin, CA 92780 | 2018-09-11 |
| 1346733573 | Elizabeth Kim Nguyen Dds Inc | Clinic/Center | 14521 Red Hill Ave, Tustin, CA 92780 | 2018-06-12 |
| 1255829503 | Hw Physical Therapy | Physical Therapist | 250 El Camino Real Ste 100, Tustin, CA 92780 | 2018-04-23 |
| 1912494352 | Gary Wayne Mcbeath | Marriage & Family Therapist | 17821 E 17th Street, Suite # 260, Tustin, CA 92780 | 2018-04-20 |
| 1104334598 | Catherine Bogues | Speech-Language Pathologist | 661 West 1st Street, Suite E, Tustin, CA 92780 | 2018-01-19 |
| 1972019941 | Lighthouse Behavioral Solutions | Behavioral Analyst | 18002 Irvine Blvd., Suite 202c, Tustin, CA 92780 | 2017-12-28 |
| 1629597299 | Lifecab, LLC | Non-emergency Medical Transport (VAN) | 13732 Newport Ave, Suite #1, Tustin, CA 92780 | 2017-09-14 |
| 1437606555 | Tustin Speech Therapy, Inc. | Speech-Language Pathologist | 661 West First Street, Suite E, Tustin, CA 92780 | 2016-09-07 |
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| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427591577 | Charlie Huang | Internal Medicine | 15000 Kensington Park Dr Ste 250, Tustin, CA 92782 | 2016-11-21 |
| 1457715682 | All Lasers Medi Spa Inc. | Internal Medicine | 13273 Jamboree Rd, Tustin, CA 92782-9159 | 2016-04-13 |
| 1164782421 | Irvine Primary Care Associates Medical Group Inc | Internal Medicine | 825 Polaris Dr, Tustin, CA 92782-1721 | 2012-05-21 |
| 1699909622 | Thao P Phung | Internal Medicine | 2913 El Camino Real Ste 316, Tustin, CA 92782-8909 | 2009-05-05 |
| 1326247669 | Don S Oh | Internal Medicine | 2488 Aquasanta, Tustin, CA 92782-1103 | 2007-07-17 |
| 1932305034 | Quyen Dao | Internal Medicine | 17542 17th St, Suite 410, Tustin, CA 92780-1959 | 2007-06-25 |
| 1295866341 | David A Mcdonough | Internal Medicine | 111 Fashion Ln Ste 200, Tustin, CA 92780-3306 | 2007-03-08 |
| 1982759114 | Jean Louis Selam | Internal Medicine | 2492 Walnut Ave, Suite # 130, Tustin, CA 92780-6953 | 2007-01-25 |
| 1043366164 | Vista Medical Partners A Professional Corporation | Internal Medicine | 1382 Valencia Ave Ste F, Tustin, CA 92780-6472 | 2007-01-25 |
| 1659451268 | Chalat Rajaram | Internal Medicine | 14901 Foxcroft Rd, Tustin, CA 92780-6726 | 2006-10-17 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.