1407044589 NPI number — DR. JOAN SY MEDICAL CORPORATION

Table of content: (NPI 1407044589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407044589 NPI number — DR. JOAN SY MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. JOAN SY MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407044589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5430 AVENIDA DEL TREN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YORBA LINDA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92887-4900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-610-9209
Provider Business Mailing Address Fax Number:
888-749-6344

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24953 PASEO DE VALENCIA STE 1A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92653-4342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-460-9200
Provider Business Practice Location Address Fax Number:
949-470-9000
Provider Enumeration Date:
10/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SY
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
YVETTE
Authorized Official Title or Position:
PHYSICIAN AND SURGEON
Authorized Official Telephone Number:
909-489-7386

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20A6587 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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