Healthcare Provider Details

I. General information

NPI: 1164830998
Provider Name (Legal Business Name): ORANGE COUNTY VASCULAR AND ENDOVASCULAR SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 07/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19582 BEACH BLVD STE 270D
HUNTINGTON BEACH CA
92648-5923
US

IV. Provider business mailing address

11190 WARNER AVE STE 301
FOUNTAIN VALLEY CA
92708-4047
US

V. Phone/Fax

Practice location:
  • Phone: 714-430-1414
  • Fax:
Mailing address:
  • Phone: 714-430-1414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA73996
License Number StateCA

VIII. Authorized Official

Name: DR. SON T DUONG
Title or Position: PRESIDENT
Credential: M.D
Phone: 714-430-1414