Healthcare Provider Details

I. General information

NPI: 1225367071
Provider Name (Legal Business Name): FOUNTAIN VALLEY PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2009
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 WARNER AVE STE 262
FOUNTAIN VALLEY CA
92708-7512
US

IV. Provider business mailing address

11100 WARNER AVE STE 262
FOUNTAIN VALLEY CA
92708-7512
US

V. Phone/Fax

Practice location:
  • Phone: 714-979-7788
  • Fax: 714-979-7799
Mailing address:
  • Phone: 714-979-7788
  • Fax: 714-979-7799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREW PIN-WEI KO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-979-7788