Healthcare Provider Details

I. General information

NPI: 1881959500
Provider Name (Legal Business Name): MICHELLE DINH NGUYEN MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

903 CRENSHAW BLVD STE.#200
LOS ANGELES CA
90019-1964
US

IV. Provider business mailing address

PO BOX 7001
TARZANA CA
91357-7001
US

V. Phone/Fax

Practice location:
  • Phone: 323-937-3333
  • Fax:
Mailing address:
  • Phone: 818-888-7815
  • Fax: 818-715-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA119712
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA119712
License Number StateCA

VIII. Authorized Official

Name: MICHELLE D DINH
Title or Position: SOLE OWNER
Credential: MD
Phone: 818-888-7815