Healthcare Provider Details

I. General information

NPI: 1558754424
Provider Name (Legal Business Name): AUNGKHIN PSYCHIATRY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2015
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1673 W BROADWAY STE 6
ANAHEIM CA
92802-1109
US

IV. Provider business mailing address

1673 W BROADWAY STE 6
ANAHEIM CA
92802-1109
US

V. Phone/Fax

Practice location:
  • Phone: 714-774-5915
  • Fax: 714-774-8095
Mailing address:
  • Phone: 714-774-5915
  • Fax: 714-774-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number9871
License Number StateCA

VIII. Authorized Official

Name: ANGELA DESAI
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 714-774-5915