Provider Demographics
NPI:1346339330
Name:EUCLID FOOT CLINIC PODIATRY GROUP, INC.
Entity Type:Organization
Organization Name:EUCLID FOOT CLINIC PODIATRY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-850-1300
Mailing Address - Street 1:PO BOX 8877
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92728-8877
Mailing Address - Country:US
Mailing Address - Phone:714-850-1300
Mailing Address - Fax:714-850-1301
Practice Address - Street 1:2621 S BRISTOL ST STE 209
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-5719
Practice Address - Country:US
Practice Address - Phone:714-850-1300
Practice Address - Fax:714-850-1301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3270213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADG9475Medicare PIN
CAW15529Medicare PIN
CAW15529AMedicare PIN
CA4985490001Medicare NSC