Healthcare Provider Details

I. General information

NPI: 1639411762
Provider Name (Legal Business Name): CALIFORNIA ORTHOPEDIC & MICRO SURGERY INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2013
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S ANAHEIM BLVD SUITE 208
ANAHEIM CA
92805
US

IV. Provider business mailing address

PO BOX 25305
ANAHEIM CA
92825-5305
US

V. Phone/Fax

Practice location:
  • Phone: 714-833-5888
  • Fax: 714-833-5688
Mailing address:
  • Phone: 714-833-5888
  • Fax: 714-833-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. GARY CHEN
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 562-547-6241