=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649545468
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GOLDEN HANDS ORTHOPEDIC GROUP, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2012
-----------------------------------------------------
Last Update Date | 03/12/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10392 CENTER DR
-----------------------------------------------------
City | VILLA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92861-4526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-337-2400
-----------------------------------------------------
Fax | 626-337-0400
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10392 CENTER DR
-----------------------------------------------------
City | VILLA PARK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92861-4526
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-337-2400
-----------------------------------------------------
Fax | 626-337-0400
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DANIEL CAPEN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 626-337-2400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------