Healthcare Provider Details

I. General information

NPI: 1205984960
Provider Name (Legal Business Name): SOUTH COAST EAR NOSE & THROAT A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CORPORATE DR SUITE 290
LADERA RANCH CA
92694
US

IV. Provider business mailing address

800 CORPORATE DR SUITE 290
LADERA RANCH CA
92694-1152
US

V. Phone/Fax

Practice location:
  • Phone: 949-218-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AVRUM AARON KAUFMAN
Title or Position: PRESIDENT
Credential: DO
Phone: 949-218-5200