Revive Regenerative Medical Group Inc

Primary specialty

Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X

Legal business name

REVIVE REGENERATIVE MEDICAL GROUP INC

Practice address

4100 Birch St Ste 200
Newport Beach, CA 92660-2275

Phone

(949) 417-0420

Fax

(877) 631-2676

NPI assigned

Jan 18, 2024

Organization subpart

No

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

Authorized official

Name

Kamer Migirdichian, DC

Title

Ceo

Phone

(949) 417-0420

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1705536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708300800000",
    "number": "1376304113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 BIRCH ST STE 200",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602275",
            "telephone_number": "949-417-0420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 BIRCH ST STE 200",
            "city": "NEWPORT BEACH",
            "state": "CA",
            "postal_code": "926602275",
            "telephone_number": "949-417-0420",
            "fax_number": "877-631-2676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE REGENERATIVE MEDICAL GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-18",
        "last_updated": "2024-02-19",
        "certification_date": "2024-02-19",
        "status": "A",
        "authorized_official_last_name": "MIGIRDICHIAN",
        "authorized_official_first_name": "KAMER",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "949-417-0420",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Providers in Newport Beach, CA by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2024; 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.