Healthcare Provider Details

I. General information

NPI: 1982960381
Provider Name (Legal Business Name): ORANGE COUNTY COSMETIC AND RECONSTRUCTIVE SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19121 BROOKHURST ST STE 201
HUNTINGTON BEACH CA
92646-2545
US

IV. Provider business mailing address

19121 BROOKHURST ST STE 201
HUNTINGTON BEACH CA
92646-2545
US

V. Phone/Fax

Practice location:
  • Phone: 714-444-4011
  • Fax:
Mailing address:
  • Phone: 714-444-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. THUAN NGUYEN
Title or Position: OWNER
Credential: MD
Phone: 714-444-4011