=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477684652
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ASSOCIATED HEAD & NECK SURGEONS OF GREATER ORANGE COUNTY INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 10/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1950 SUNNYCREST DR STE 3800
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-3647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-447-4100
-----------------------------------------------------
Fax | 714-447-1923
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2240 N HARBOR BLVD STE 200
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92835-2635
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-447-4100
-----------------------------------------------------
Fax | 714-447-1923
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MRS. REBECCA JANSEN I
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-447-4100
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------