1134630981 NPI number — HUNTINGTON FOOT & ANKLE CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134630981 NPI number — HUNTINGTON FOOT & ANKLE CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HUNTINGTON FOOT & ANKLE CARE, 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:
1134630981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12062 VALLEY VIEW ST STE 131
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARDEN GROVE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92845-1741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-465-2178
Provider Business Mailing Address Fax Number:
714-465-2179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12062 VALLEY VIEW ST STE 131
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN GROVE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92845-1741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-465-2178
Provider Business Practice Location Address Fax Number:
714-465-2179
Provider Enumeration Date:
10/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MAI
Authorized Official First Name:
CONG
Authorized Official Middle Name:
THANH
Authorized Official Title or Position:
PODIATRIST/OWNER
Authorized Official Telephone Number:
714-465-2178

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  A300277 , 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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