Healthcare Provider Details

I. General information

NPI: 1437875390
Provider Name (Legal Business Name): 9-FIVE CLINICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 E ANAHEIM ST
LONG BEACH CA
90813-3908
US

IV. Provider business mailing address

9041 MAGNOLIA AVE STE 302
RIVERSIDE CA
92503-3957
US

V. Phone/Fax

Practice location:
  • Phone: 562-349-0030
  • Fax: 888-251-0984
Mailing address:
  • Phone: 562-349-0030
  • Fax: 888-251-0984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT NGUYEN
Title or Position: PRESDIENT
Credential: MD
Phone: 951-756-3113