Provider Demographics
NPI:1386844645
Name:EAR, NOSE, THROAT AND ALLERGY GROUP, INC.
Entity Type:Organization
Organization Name:EAR, NOSE, THROAT AND ALLERGY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-669-4478
Mailing Address - Street 1:P.O. BOX 3746
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92781
Mailing Address - Country:US
Mailing Address - Phone:714-669-4478
Mailing Address - Fax:714-669-4057
Practice Address - Street 1:14642 NEWPORT AVENUE
Practice Address - Street 2:250
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-669-4478
Practice Address - Fax:714-669-4057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88781Medicare UPIN