Fullerton Orthopaedic Surgery Medical Group, Inc.

Primary specialty

SpecialistTaxonomy code 174400000X

License

20A9973 Issued in CA

Legal business name

FULLERTON ORTHOPAEDIC SURGERY MEDICAL GROUP, INC.

Practice address

15039 Goldenwest St
Huntington Beach, CA 92647-2710

Phone

(714) 893-7400

Fax

(714) 893-7022

NPI assigned

Aug 4, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kendall Wagner

Title

President

Phone

(714) 879-0050

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1312416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312416000000",
    "number": "1174802433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 LAGUNA RD STE A",
            "city": "FULLERTON",
            "state": "CA",
            "postal_code": "928353635",
            "telephone_number": "714-879-0050",
            "fax_number": "714-879-0249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15039 GOLDENWEST ST",
            "city": "HUNTINGTON BEACH",
            "state": "CA",
            "postal_code": "926472710",
            "telephone_number": "714-893-7400",
            "fax_number": "714-893-7022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULLERTON ORTHOPAEDIC SURGERY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-04",
        "last_updated": "2011-08-04",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "KENDALL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "714-879-0050"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "20A9973",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "W1365",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Huntington Beach, CA
• Providers in Huntington Beach, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.