=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124252408
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CYS NHAN HOA OCAPICA FSP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2009
-----------------------------------------------------
Last Update Date | 05/14/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14221 EUCLID ST STE H
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-4991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-539-9999
-----------------------------------------------------
Fax | 714-539-9015
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14221 EUCLID ST STE H
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-4991
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-539-9999
-----------------------------------------------------
Fax | 714-539-9015
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | INTERIM EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MRS. MY HANH NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-539-9999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 145620
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------