Provider Demographics
NPI:1538563549
Name:NEWHOPE JOINT & SPINE MEDICAL CENTER
Entity type:Organization
Organization Name:NEWHOPE JOINT & SPINE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHUONG
Authorized Official - Middle Name:Q
Authorized Official - Last Name:TIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-333-3333
Mailing Address - Street 1:14120 BEACH BLVD STE 180
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4454
Mailing Address - Country:US
Mailing Address - Phone:714-333-3333
Mailing Address - Fax:714-891-3234
Practice Address - Street 1:14120 BEACH BLVD STE 180
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4454
Practice Address - Country:US
Practice Address - Phone:714-333-3333
Practice Address - Fax:714-891-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-20
Last Update Date:2020-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1118422081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGM656Medicare PIN