Provider Demographics
NPI:1811465719
Name:GREATER ORANGE COUNTY EAR NOSE THROAT HEAD & NECK SURGEONS INC
Entity type:Organization
Organization Name:GREATER ORANGE COUNTY EAR NOSE THROAT HEAD & NECK SURGEONS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:Y
Authorized Official - Last Name:WAKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-447-4100
Mailing Address - Street 1:2240 N HARBOR BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2635
Mailing Address - Country:US
Mailing Address - Phone:714-447-4100
Mailing Address - Fax:714-447-1922
Practice Address - Street 1:2240 N HARBOR BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2635
Practice Address - Country:US
Practice Address - Phone:714-447-4100
Practice Address - Fax:714-447-1922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GREATER ORANGE COUNTY EAR NOSE THROAT HEAD & NECK SURGEONS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-08
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty