Healthcare Provider Details

I. General information

NPI: 1831973049
Provider Name (Legal Business Name): MSO, INC. OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 08/21/2023
Certification Date: 08/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17622 ARMSTRONG AVE
IRVINE CA
92614-5728
US

IV. Provider business mailing address

17622 ARMSTRONG AVE
IRVINE CA
92614-5728
US

V. Phone/Fax

Practice location:
  • Phone: 626-656-2370
  • Fax: 866-627-3093
Mailing address:
  • Phone: 626-656-2370
  • Fax: 866-627-3093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. LAN PHAN
Title or Position: CEO
Credential:
Phone: 818-399-8996