Provider Demographics
NPI:1801922521
Name:DOAN VAN, NICHOLAS N (MD, FACC INC)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:N
Last Name:DOAN VAN
Suffix:
Gender:M
Credentials:MD, FACC INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18111 BROOKHURST ST
Mailing Address - Street 2:SUITE 5100
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-6728
Mailing Address - Country:US
Mailing Address - Phone:714-546-2238
Mailing Address - Fax:714-434-8145
Practice Address - Street 1:18111 BROOKHURST ST
Practice Address - Street 2:SUITE 5100
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6728
Practice Address - Country:US
Practice Address - Phone:714-546-2238
Practice Address - Fax:714-434-8145
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA68391174400000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49298YMedicaid
CAYYY49298YMedicaid
CAF70514Medicare UPIN