Unknown Individual – Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician, NPI 1710077136

Unknown Individual is a healthcare provider. based in Fountain valley, California. specializing in Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician. They hold a License No. C42391 (CA). The NPI Number for Unknown Individual is 1710077136

Main info

Organization
Inactive
59 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1710077136
Phone
(714) 549-1294
Address
11100 WARNER AVE
Deactivation Date
13 November 2025

Doctor Profile

Medical School Name
OTHER
Secondary Phone
-
Graduation Year
1967 (59 years ago)
PAC ID
1557407376
Professional Enrollment ID
I20091008000550
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Medical Offices, 11100, Warner Avenue, Fountain Valley, Orange County, California, 92708, United States

    # 320

    FOUNTAIN VALLEY, CA 927087511

    Phone: (714) 549-1294

    Fax: (714) 549-1296

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $177.

Total Amount is formed as General ($177) + Research ($0) + Ownership ($0) = $177.

Last reported payment date: 2023-07-31 • Largest payer in this snapshot: LeMaitre Vascular, Inc. ($147).

Total Amount

$177

General + Research + Ownership

Payments

2

Total payment records

General Amount

$177

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-07-31

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
33533Coronary artery bypass using artery graft, 1 graft1212$0
View full utilization report →

Insurance plans in this area (ZIP 92708)

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Provider's Procedures

Unknown Individual performs procedures in Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician. See the list of HCPCS codes below.
SpecialtyPractice State
HCPCS Code
Description
Service Count
Beneficiary Count
THORACIC SURGERYCA33533Heart artery bypass to repair one artery1717

Reviews

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Frequently asked questions

Where can patients find Unknown Individual's NPI?
You can confirm Unknown Individual with NPI 1710077136; it appears in the national provider directory.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
What kind of provider is Unknown Individual?
The page reflects Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Fountain Valley, California for Unknown Individual; download NPPES for the complete set.
Is Unknown Individual a real provider?
This page reflects official NPPES data for NPI 1710077136. Always confirm identity and privileges with the practice and licensing boards.

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