Provider Demographics
NPI:1982960381
Name:ORANGE COUNTY COSMETIC AND RECONSTRUCTIVE SURGERY CENTER
Entity Type:Organization
Organization Name:ORANGE COUNTY COSMETIC AND RECONSTRUCTIVE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THUAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-444-4011
Mailing Address - Street 1:19121 BROOKHURST ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-2545
Mailing Address - Country:US
Mailing Address - Phone:714-444-4011
Mailing Address - Fax:
Practice Address - Street 1:19121 BROOKHURST ST STE 101
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-2545
Practice Address - Country:US
Practice Address - Phone:714-444-4011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-10
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical