Eunji Back
Individual provider Active NPI Physician Assistant · Laguna Woods, CA
NPI 1942919675 · NPPES record last updated Jan 23, 2024
Key facts
- NPI
- 1942919675
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- PA63479 (CA)
- Practice address
- 24331 El Toro Rd Ste 200
Laguna Woods, CA 92637-3116 - Phone
- (949) 586-3200
- NPI assigned
- Nov 21, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Orthowest
Practice addresses (Care Compare)
22 Odyssey
Suite 205
Irvine, CA 92618-3197
Phone (949) 586-3200
Hospital & facility affiliations
- Memorialcare Saddleback Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240208001179 | CA | Practitioner - Physician Assistant | 8820431661 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA63479 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Orthowest | Physician Assistant | Current |
Accepting new patients |
| Orthowest | Past | Accepting new patients |
Locations
22 Odyssey
Ste 205
Irvine, CA 92618
Phone (949) 870-3332
24331 El Toro Rd
Ste 200
Laguna Woods, CA 92637
Phone (949) 767-0800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Physician Assistant | 363A00000X | PA63479 | CA | Yes |
Addresses
Primary practice location
24331 El Toro Rd Ste 200
Laguna Woods, CA 92637-3116
Mailing address
9412 Canterbury LN
Garden Grove, CA 92841-3431
Other providers in Laguna Woods, CA
- Arshia Roohian DPM Inc.
- Arthritis and Rheumatic Disease Center, Inc.
- Ascend Laguna Woods Physical Therapy, Inc
- Danny Mario Asfahani
- Audiogenic Inc
- Terra J Barnes
- Bci Orthopaedics
- Keith Garold Beebe
- Beltone-Krone Hearing Aid Center
- Hannah Pelton Bensky
All providers in Laguna Woods, CA · Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.