NPIMap

Organization Active NPI

Ebenezer Wellness Center, Inc.

  • General Practice Physician
  • Irvine, CA
National Provider Identifier
1114339272
Registry record updated May 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
A86714 Issued in CA
Legal business name
EBENEZER WELLNESS CENTER, INC.
Practice address
16261 Laguna Canyon Rd
Suite 100
Irvine, CA 92618-3608
Phone
(714) 636-3886
NPI assigned
May 23, 2014
Last updated
May 23, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Junghee Kim, L.ACNPI 1497904601
Title
Vice President
Phone
(714) 618-3942

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X A86714 CA Primary

Addresses

Primary practice location

16261 Laguna Canyon Rd
Suite 100
Irvine, CA 92618-3608

Mailing address

16261 Laguna Canyon Rd
Suite 100
Irvine, CA 92618-3608
Phone (714) 636-3886

National Provider Directory

National Provider Directory

Locations

16261 Laguna Canyon Rd
#100
Irvine, CA 92618
Phone (714) 636-3886

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1400803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400803200000",
    "number": "1114339272",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16261 LAGUNA CANYON RD",
            "address_2": "SUITE 100",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183608",
            "telephone_number": "714-636-3886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16261 LAGUNA CANYON RD",
            "address_2": "SUITE 100",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926183608",
            "telephone_number": "714-636-3886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER WELLNESS CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-23",
        "last_updated": "2014-05-23",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "JUNGHEE",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "714-618-3942",
        "authorized_official_credential": "L.AC"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A86714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Irvine, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.