Healthcare Provider Details

I. General information

NPI: 1467400192
Provider Name (Legal Business Name): LP ANGEL MEDICAL CENTER, A PROF. CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 W ORANGE AVE SUITE 120
ANAHEIM CA
92804-3153
US

IV. Provider business mailing address

3111 W ORANGE AVE 120
ANAHEIM CA
92804-3153
US

V. Phone/Fax

Practice location:
  • Phone: 714-229-9892
  • Fax: 714-229-9682
Mailing address:
  • Phone: 714-229-9892
  • Fax: 714-229-9682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HYUNG WON OH
Title or Position: CEO
Credential: M.D.
Phone: 714-229-9892