Healthcare Provider Details

I. General information

NPI: 1598937476
Provider Name (Legal Business Name): NATHANIEL HO, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 03/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23321 EL TORO RD STE H
LAKE FOREST CA
92630-4892
US

IV. Provider business mailing address

17018 SAN RICARDO ST
FOUNTAIN VALLEY CA
92708-3819
US

V. Phone/Fax

Practice location:
  • Phone: 949-305-2660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA73933
License Number StateCA

VIII. Authorized Official

Name: DR. NATHANIEL HO
Title or Position: MD/PRESIDENT
Credential:
Phone: 714-391-1901