Provider Demographics
NPI:1144674169
Name:JOHN C. STORCH, M.D., INC.
Entity type:Organization
Organization Name:JOHN C. STORCH, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:STORCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-650-2887
Mailing Address - Street 1:350 OLD NEWPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4148
Mailing Address - Country:US
Mailing Address - Phone:949-650-2887
Mailing Address - Fax:949-642-1620
Practice Address - Street 1:350 OLD NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4148
Practice Address - Country:US
Practice Address - Phone:949-650-2887
Practice Address - Fax:949-642-1620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-15
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG50974OtherCALIFORNIA STATE LICENSE