Healthcare Provider Details

I. General information

NPI: 1053557918
Provider Name (Legal Business Name): HOAG ENDOSCOPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/24/2008
Last Update Date: 12/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUPERIOR AVE SUITE 120
NEWPORT BEACH CA
92663-3657
US

IV. Provider business mailing address

500 SUPERIOR AVE SUITE 120
NEWPORT BEACH CA
92663-3657
US

V. Phone/Fax

Practice location:
  • Phone: 949-722-9600
  • Fax: 949-722-0600
Mailing address:
  • Phone: 949-722-9600
  • Fax: 949-722-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA TSAI
Title or Position: CHAIRMAN BOARD OF GOVERNORS
Credential: MD
Phone: 949-650-4630