Healthcare Provider Details

I. General information

NPI: 1902065220
Provider Name (Legal Business Name): ALLERGY ASSOCIATES OF ORANGE COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19871 YORBA LINDA BLVD SUITE 104
YORBA LINDA CA
92886-2811
US

IV. Provider business mailing address

14 INGLESIDE
IRVINE CA
92620-2890
US

V. Phone/Fax

Practice location:
  • Phone: 714-777-8845
  • Fax: 714-777-8856
Mailing address:
  • Phone: 714-310-7781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA68359
License Number StateCA

VIII. Authorized Official

Name: DR. HAE YOUNG AARON SONG
Title or Position: OWNER
Credential: M.D.
Phone: 714-310-7781