Healthcare Provider Details

I. General information

NPI: 1437200276
Provider Name (Legal Business Name): CHILDREN & ADULTS MED GR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 N SPRING ST STE #4
LOS ANGELES CA
90012-2814
US

IV. Provider business mailing address

9246 E VALLEY BLVD #C
ROSEMEAD CA
91770
US

V. Phone/Fax

Practice location:
  • Phone: 213-928-0866
  • Fax: 213-928-0868
Mailing address:
  • Phone: 626-641-2117
  • Fax: 626-573-3754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A6867
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A6867
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID HUU NGUYEN
Title or Position: PHYSICIAN OWNER OR PRESIDENT
Credential: DO
Phone: 213-928-0866