Provider Demographics
NPI:1285893107
Name:ORANGE COUNTY VASCULAR & ENDOVASCULAR SURGERY CENTER, INC.
Entity type:Organization
Organization Name:ORANGE COUNTY VASCULAR & ENDOVASCULAR SURGERY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SON
Authorized Official - Middle Name:THANH
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-430-1414
Mailing Address - Street 1:11190 WARNER AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4047
Mailing Address - Country:US
Mailing Address - Phone:714-430-1414
Mailing Address - Fax:714-430-1486
Practice Address - Street 1:11190 WARNER AVE STE 408
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4047
Practice Address - Country:US
Practice Address - Phone:714-430-1414
Practice Address - Fax:714-430-1486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA739962086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty