Healthcare Provider Details

I. General information

NPI: 1073173860
Provider Name (Legal Business Name): HEAD AND NECK ASSOCIATES OF CENTRAL CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2019
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 N FRESNO ST STE 490
FRESNO CA
93701-0000
US

IV. Provider business mailing address

215 N FRESNO ST STE 490
FRESNO CA
93701-0000
US

V. Phone/Fax

Practice location:
  • Phone: 559-459-4101
  • Fax: 559-459-5744
Mailing address:
  • Phone: 559-459-4101
  • Fax: 559-459-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: BRIAN MICHAEL WOO
Title or Position: GEN PARTNER
Credential: DDS, MD
Phone: 559-459-4101