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General NPI Number Information
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NPI Number | 1386844645
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Entity Type | Organization
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Legal Business Name | EAR, NOSE, THROAT AND ALLERGY GROUP, INC.
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Dates
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Enumeration Date | 07/24/2007
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Last Update Date | 07/24/2007
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Provider Practice Location Address
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Address Line | 14642 NEWPORT AVENUE 250
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 714-669-4478
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Fax | 714-669-4057
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Provider Business Mailing Address
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Address Line | P.O. BOX 3746
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City | TUSTIN
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State | CA
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Zip | 92781
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Country | US
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Telephone | 714-669-4478
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Fax | 714-669-4057
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. ALBERT S. GOH
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Credential | MD
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Telephone | 714-669-4478
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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