1225073562 NPI number — KHIEM PV NGUYEN MD CARDIOLOGY ASSOCIATES MEDICAL GROUP INC

Table of content: VICTORIA ANN ENGEL D.O. (NPI 1629006341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225073562 NPI number — KHIEM PV NGUYEN MD CARDIOLOGY ASSOCIATES MEDICAL GROUP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KHIEM PV NGUYEN MD CARDIOLOGY ASSOCIATES MEDICAL GROUP 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:
1225073562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1245 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 703
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90017-4807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-977-0419
Provider Business Mailing Address Fax Number:
213-250-9416

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 S ATLANTIC BLVD
Provider Second Line Business Practice Location Address:
SUITE 305
Provider Business Practice Location Address City Name:
MONTEREY PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91754-4729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-282-5541
Provider Business Practice Location Address Fax Number:
626-281-8320
Provider Enumeration Date:
06/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
KHIEM
Authorized Official Middle Name:
PV
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
714-775-4400

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G573012 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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