Provider Demographics
NPI:1093736118
Name:ORANGE DOCTORS OF KIDS AND TEENS
Entity Type:Organization
Organization Name:ORANGE DOCTORS OF KIDS AND TEENS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-639-3914
Mailing Address - Street 1:1310 W. STEWART DRIVE
Mailing Address - Street 2:SUITE #506
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868
Mailing Address - Country:US
Mailing Address - Phone:714-639-3914
Mailing Address - Fax:714-538-5427
Practice Address - Street 1:1310 W. STEWART DRIVE
Practice Address - Street 2:SUITE #506
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-639-3914
Practice Address - Fax:714-538-5427
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization