Basic Information
| Provider Information | |||||||||
| NPI: | 1629578455 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LIFANG MAO MD INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5486 | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928635486 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8185500900 | ||||||||
| FaxNumber: | 3039538260 | ||||||||
| Practice Location | |||||||||
| Address1: | 12601 GARDEN GROVE BLVD | ||||||||
| Address2: | |||||||||
| City: | GARDEN GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928431908 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7147412772 | ||||||||
| FaxNumber: | 7147413364 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2018 | ||||||||
| LastUpdateDate: | 02/19/2018 | ||||||||
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| AuthorizedOfficialLastName: | MEHRER | ||||||||
| AuthorizedOfficialFirstName: | TAMMY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8185500900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A132423 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.