Healthcare Provider Details

I. General information

NPI: 1629214143
Provider Name (Legal Business Name): CALIFORNIA HEART
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2009
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18800 MAIN ST
HUNTINGTON BEACH CA
92648-1707
US

IV. Provider business mailing address

18800 MAIN ST 103
HUNTINGTON BEACH CA
92648-1707
US

V. Phone/Fax

Practice location:
  • Phone: 714-842-8100
  • Fax:
Mailing address:
  • Phone: 714-842-8100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QG0250X
TaxonomyGenetics Clinic/Center
License Number17458
License Number StateCA

VIII. Authorized Official

Name: MISS LI YAO
Title or Position: NP
Credential: NP
Phone: 626-215-6903