Provider Demographics
NPI:1447751227
Name:SAN DIEGO HEART ARRHYTHMIA CENTER, AMC
Entity Type:Organization
Organization Name:SAN DIEGO HEART ARRHYTHMIA CENTER, AMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:TUAN
Authorized Official - Middle Name:VAN
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-297-0014
Mailing Address - Street 1:501 WASHINGTON ST STE 512
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2238
Mailing Address - Country:US
Mailing Address - Phone:619-297-0014
Mailing Address - Fax:619-297-1014
Practice Address - Street 1:501 WASHINGTON ST STE 512
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-297-1014
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-27
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA113870207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty