Provider Demographics
NPI:1588068191
Name:HARBOR NEUROLOGICAL GROUP
Entity type:Organization
Organization Name:HARBOR NEUROLOGICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:714-705-0737
Mailing Address - Street 1:21039 FIGUEROA ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-1972
Mailing Address - Country:US
Mailing Address - Phone:714-705-0737
Mailing Address - Fax:310-618-6989
Practice Address - Street 1:13701 BEACH BLVD
Practice Address - Street 2:SUITE A1
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-3203
Practice Address - Country:US
Practice Address - Phone:714-705-0737
Practice Address - Fax:310-388-5802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-13
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64097207RI0200X
CAE4237213EP1101X
CAA866322084N0400X
207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty