Healthcare Provider Details

I. General information

NPI: 1669403549
Provider Name (Legal Business Name): HENRY VAN GIESON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 11/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2898 LINDEN AVE
LONG BEACH CA
90806
US

IV. Provider business mailing address

2898 LINDEN AVE
LONG BEACH CA
90806
US

V. Phone/Fax

Practice location:
  • Phone: 562-595-8671
  • Fax: 562-490-2015
Mailing address:
  • Phone: 562-595-8671
  • Fax: 562-490-2015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG74156
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberG74156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: