Basic Information
| Provider Information | |||||||||
| NPI: | 1356425896 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORTHOPEDIC SURGERY & SPORTS MEDICINE GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 S HARBOR BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906317577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148793400 | ||||||||
| FaxNumber: | 7144411998 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 S HARBOR BLVD STE A | ||||||||
| Address2: | |||||||||
| City: | LA HABRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906317577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148793400 | ||||||||
| FaxNumber: | 7144411998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | KAPLAN | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7148793400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | GR0050781 | 05 | CA | MEDICAID |