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General NPI Number Information
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NPI Number | 1336335322
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Entity Type | Individual
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Provider Name | ARMAND WIDJAJA M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 03/03/2020
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Provider Practice Location Address
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Address Line | 250 E YALE LOOP STE 200
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City | IRVINE
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State | CA
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Zip | 92604-4697
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Country | US
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Telephone | 949-551-1090
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Fax | 949-262-5500
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Provider Business Mailing Address
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Address Line | 17360 BROOKHURST ST ATTN: NETWORK MANAGEMENT
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3720
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Country | US
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Telephone | 714-549-1300
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A98710
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License Number State | CA
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