Provider Demographics
NPI:1528822210
Name:ORANGE COUNTY RECONSTRUCTIVE AND AESTHETIC SURGERY
Entity type:Organization
Organization Name:ORANGE COUNTY RECONSTRUCTIVE AND AESTHETIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KHANG
Authorized Official - Middle Name:T
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-321-0779
Mailing Address - Street 1:3991 MACARTHUR BLVD STE 320
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3004
Mailing Address - Country:US
Mailing Address - Phone:949-720-3888
Mailing Address - Fax:
Practice Address - Street 1:3991 MACARTHUR BLVD STE 320
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3004
Practice Address - Country:US
Practice Address - Phone:949-720-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty