Provider Demographics
NPI:1356425896
Name:ORTHOPEDIC SURGERY & SPORTS MEDICINE GROUP
Entity type:Organization
Organization Name:ORTHOPEDIC SURGERY & SPORTS MEDICINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAPLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-879-3400
Mailing Address - Street 1:1400 S HARBOR BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-7577
Mailing Address - Country:US
Mailing Address - Phone:714-879-3400
Mailing Address - Fax:714-441-1998
Practice Address - Street 1:1400 S HARBOR BLVD STE A
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-7577
Practice Address - Country:US
Practice Address - Phone:714-879-3400
Practice Address - Fax:714-441-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0050781Medicaid
CAQ40908Medicare UPIN
CAR36547Medicare UPIN
CAWG34562BMedicare ID - Type Unspecified
CAA52284Medicare UPIN
CAWA82726BMedicare ID - Type Unspecified
CAGR0050781Medicaid
CAA51038Medicare UPIN
CAS65474Medicare UPIN
CAW1087AMedicare ID - Type Unspecified
CAWG52530BMedicare ID - Type Unspecified
CAA45978Medicare UPIN
CAA82726Medicare UPIN
CAGR0050781Medicare ID - Type Unspecified