Healthcare Provider Details

I. General information

NPI: 1831586387
Provider Name (Legal Business Name): PETE POW-ANPONGKUL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 WARNER AVE STE 351
FOUNTAIN VALLEY CA
92708-7516
US

IV. Provider business mailing address

11180 WARNER AVE STE 351
FOUNTAIN VALLEY CA
92708-7516
US

V. Phone/Fax

Practice location:
  • Phone: 714-698-0300
  • Fax: 714-698-0313
Mailing address:
  • Phone: 714-698-0300
  • Fax: 714-698-0313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA144575
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License NumberA144575
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberA144575
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberA144575
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: