1720307655 NPI number — CALIFORNIA CARDIAC CENTER, INC.

Table of content: (NPI 1720307655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720307655 NPI number — CALIFORNIA CARDIAC CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALIFORNIA CARDIAC CENTER, INC.
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:
1720307655
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
307 PLACENTIA AVE
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92663-3310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-631-4278
Provider Business Mailing Address Fax Number:
949-548-4278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
307 PLACENTIA AVE
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-3310
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-631-4278
Provider Business Practice Location Address Fax Number:
949-548-4278
Provider Enumeration Date:
05/17/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
AGHA
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
949-631-4278

Provider Taxonomy Codes

  • Taxonomy code: 207RI0011X , with the licence number:  C53047 , 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)

  • Identifier: FNP 40010 . This is a "FICTITIOUS NAME PERMIT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: C3274073 . This is a "CA BUSINESS LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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