Healthcare Provider Details

I. General information

NPI: 1962216887
Provider Name (Legal Business Name): MODRYN PRACTICE, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2025
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 BUENA VISTA ST STE E
DUARTE CA
91010-2486
US

IV. Provider business mailing address

1227 BUENA VISTA ST STE E
DUARTE CA
91010-2486
US

V. Phone/Fax

Practice location:
  • Phone: 877-254-4496
  • Fax:
Mailing address:
  • Phone: 877-254-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ULIN SARGEANT
Title or Position: OWNER
Credential: MD
Phone: 877-254-4496