Provider Demographics
NPI:1639611445
Name:UNDONO CARE ANAHEIM 1, LLC
Entity Type:Organization
Organization Name:UNDONO CARE ANAHEIM 1, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMLIEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-717-0088
Mailing Address - Street 1:1248 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-5116
Mailing Address - Country:US
Mailing Address - Phone:714-883-9541
Mailing Address - Fax:888-568-3105
Practice Address - Street 1:1248 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-5116
Practice Address - Country:US
Practice Address - Phone:714-883-9541
Practice Address - Fax:888-568-3105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty