Healthcare Provider Details

I. General information

NPI: 1568045714
Provider Name (Legal Business Name): LISA NHAN DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 04/25/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2073 ATLANTIC AVE
LONG BEACH CA
90806-4935
US

IV. Provider business mailing address

2073 ATLANTIC AVE
LONG BEACH CA
90806-4935
US

V. Phone/Fax

Practice location:
  • Phone: 626-377-8363
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: LISA NHAN
Title or Position: PRESIDENT
Credential: DPM
Phone: 626-377-8363