Healthcare Provider Details

I. General information

NPI: 1043409022
Provider Name (Legal Business Name): ENT AND SINUS CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MEDICAL CENTER DR SUITE 105
SAN BERNARDINO CA
92411-1218
US

IV. Provider business mailing address

1800 MEDICAL CENTER DR SUITE 105
SAN BERNARDINO CA
92411-1218
US

V. Phone/Fax

Practice location:
  • Phone: 909-880-2000
  • Fax: 909-880-1102
Mailing address:
  • Phone: 909-880-2000
  • Fax: 909-880-1102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberG83603
License Number StateCA

VIII. Authorized Official

Name: DR. HENRY HUY NGUYEN
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 909-880-2000