Healthcare Provider Details

I. General information

NPI: 1205494838
Provider Name (Legal Business Name): AB GYNECOLOGY & UROLOGY MEDICAL INSTITUTION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2019
Last Update Date: 05/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 DELAWARE ST STE 550
HUNTINGTON BEACH CA
92648-6085
US

IV. Provider business mailing address

18685 MAIN ST STE 101-388
HUNTINGTON BEACH CA
92648-1723
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-3600
  • Fax: 714-375-3605
Mailing address:
  • Phone: 714-375-3600
  • Fax: 714-375-3605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ARAM BONNI
Title or Position: OWNER
Credential: MD
Phone: 714-375-3600