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General NPI Number Information
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NPI Number | 1215475983
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Entity Type | Organization
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Legal Business Name | ADVANCED WOUND HEALING SPECIALISTS, INC.
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Dates
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Enumeration Date | 02/02/2017
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Last Update Date | 02/15/2017
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Provider Practice Location Address
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Address Line | 2190 LYNN RD STE 320
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-8026
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Country | US
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Telephone | 805-370-4325
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Fax |
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Provider Business Mailing Address
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Address Line | 13990 BEAR FENCE CT
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City | MOORPARK
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State | CA
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Zip | 93021-5022
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Country | US
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Telephone | 818-718-2301
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRUNG BUI
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Credential | M.D.
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Telephone | 805-370-4325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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