Provider Demographics
NPI:1104020338
Name:RADIANCE OUTPATIENT SURGERY CENTRE
Entity Type:Organization
Organization Name:RADIANCE OUTPATIENT SURGERY CENTRE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THANH
Authorized Official - Middle Name:N
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-418-9499
Mailing Address - Street 1:9842 BOLSA AVE # 200-A
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6680
Mailing Address - Country:US
Mailing Address - Phone:714-418-9499
Mailing Address - Fax:
Practice Address - Street 1:9842 BOLSA AVE # 200-A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6680
Practice Address - Country:US
Practice Address - Phone:714-418-9499
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71173OtherSTATE LICENSE NO.