Provider Demographics
NPI:1073862058
Name:LN SURGERY CLINIC
Entity Type:Organization
Organization Name:LN SURGERY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAN
Authorized Official - Middle Name:KHAC
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-636-8196
Mailing Address - Street 1:13071 BROOKHURST ST
Mailing Address - Street 2:SUITE # 160
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1091
Mailing Address - Country:US
Mailing Address - Phone:714-636-8196
Mailing Address - Fax:714-636-8197
Practice Address - Street 1:13071 BROOKHURST ST
Practice Address - Street 2:SUITE # 160
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1091
Practice Address - Country:US
Practice Address - Phone:714-636-8196
Practice Address - Fax:714-636-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45981261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
C50383Medicare UPIN