Basic Information
| Provider Information | |||||||||
| NPI: | 1477684652 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ASSOCIATED HEAD & NECK SURGEONS OF GREATER ORANGE COUNTY INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2240 N HARBOR BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928352635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144474100 | ||||||||
| FaxNumber: | 7144471923 | ||||||||
| Practice Location | |||||||||
| Address1: | 1950 SUNNYCREST DR STE 3800 | ||||||||
| Address2: | |||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928353647 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144474100 | ||||||||
| FaxNumber: | 7144471923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 10/02/2019 | ||||||||
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| AuthorizedOfficialLastName: | JANSEN | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7144474100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | I | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | GR0058670 | 05 | CA | MEDICAID | CS4872 | 01 | CA | RAILROAD MEDICARE | OTHER |