Healthcare Provider Details

I. General information

NPI: 1689766800
Provider Name (Legal Business Name): HCA BH LPS MHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST SUITE 550
SANTA ANA CA
92701-4519
US

IV. Provider business mailing address

11911 WEST ST
GARDEN GROVE CA
92840-2552
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-4707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THIET VAN PHAN
Title or Position: MHS
Credential:
Phone: 714-834-6843