Healthcare Provider Details

I. General information

NPI: 1669573663
Provider Name (Legal Business Name): PRIMAYTAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 N ROSE DR
PLACENTIA CA
92870-3802
US

IV. Provider business mailing address

PO BOX 4259
CERRITOS CA
90703-4259
US

V. Phone/Fax

Practice location:
  • Phone: 562-407-2080
  • Fax: 562-407-2082
Mailing address:
  • Phone: 562-407-2080
  • Fax: 562-407-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN HUANG
Title or Position: PRESIDENT
Credential: MD
Phone: 562-407-2080