=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710914288
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | USCC AQUISITIONS CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/28/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 S FOREST RD
-----------------------------------------------------
City | SONORA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95370-4816
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-536-0223
-----------------------------------------------------
Fax | 209-536-0226
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 610 NEWPORT CENTER DR SUITE 350
-----------------------------------------------------
City | NEWPORT BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92660-6419
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-721-6540
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | GARY S YOUNG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 949-721-6533
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | G61579
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------