Provider Demographics
NPI:1043409022
Name:ENT AND SINUS CENTER P C
Entity Type:Organization
Organization Name:ENT AND SINUS CENTER P C
Other - Org Name:ENT AND SINUS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:HUY
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-880-2000
Mailing Address - Street 1:1800 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92411-1218
Mailing Address - Country:US
Mailing Address - Phone:909-880-2000
Mailing Address - Fax:909-880-1102
Practice Address - Street 1:1800 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 105
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1218
Practice Address - Country:US
Practice Address - Phone:909-880-2000
Practice Address - Fax:909-880-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83603207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529919950Medicaid
ALJ856Medicare PIN