Beach Obstetrics & Gynecology Medical Group a Medical Corporation

Primary specialty

SpecialistTaxonomy code 174400000X

License

G067729 Issued in CA

Legal business name

BEACH OBSTETRICS & GYNECOLOGY MEDICAL GROUP A MEDICAL CORPORATION

Practice address

19582 Beach Blvd Ste 202
Huntington Beach, CA 92648-2996

Phone

(714) 841-9899

Fax

(714) 841-2729

NPI assigned

Jun 25, 2007

Last updated

Apr 6, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jeffrey Stuart Illeck, MDNPI 1013920958

Title

President

Phone

(714) 841-9899

Specialties & licenses 1

Addresses

Locations

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.

• Jeffrey Stuart Illeck, M.D.

  • Obstetrics & Gynecology Physician
  • Huntington Beach, CA
  • NPI 1013920958
  Authorized official Same address or phone
• Johanna Dubyak, M.D.

  • Obstetrics & Gynecology Physician
  • Huntington Beach, CA
  • NPI 1154334001
  NPD (past)

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554508800000",
    "number": "1366648594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19582 BEACH BLVD STE 202",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926482996",
            "telephone_number": "714-841-9899",
            "fax_number": "714-841-2729"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19582 BEACH BLVD STE 202",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926482996",
            "telephone_number": "714-841-9899",
            "fax_number": "714-841-2729"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 Superior Ave Ste 330",
            "address_purpose": "LOCATION",
            "city": "Newport Beach",
            "state": "CA",
            "postal_code": "926633658",
            "country_code": "US",
            "telephone_number": "949-438-2440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEACH OBSTETRICS & GYNECOLOGY MEDICAL GROUP A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2019-04-06",
        "status": "A",
        "authorized_official_last_name": "ILLECK",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "STUART",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-841-9899",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G067729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2019; 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.