Healthcare Provider Details

I. General information

NPI: 1881237824
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA FAMILY MEDICINE CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 10/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

709 N HILL ST STE 19
LOS ANGELES CA
90012-2352
US

IV. Provider business mailing address

709 N HILL ST STE 19
LOS ANGELES CA
90012-2352
US

V. Phone/Fax

Practice location:
  • Phone: 213-537-0816
  • Fax: 213-537-0812
Mailing address:
  • Phone: 213-537-0816
  • Fax: 213-537-0812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DAVID H NGUYEN
Title or Position: PRESIDENT
Credential: DO
Phone: 626-641-2119