Healthcare Provider Details

I. General information

NPI: 1225073562
Provider Name (Legal Business Name): KHIEM PV NGUYEN MD CARDIOLOGY ASSOCIATES MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 S ATLANTIC BLVD SUITE 305
MONTEREY PARK CA
91754-4729
US

IV. Provider business mailing address

1245 WILSHIRE BLVD SUITE 703
LOS ANGELES CA
90017-4807
US

V. Phone/Fax

Practice location:
  • Phone: 626-282-5541
  • Fax: 626-281-8320
Mailing address:
  • Phone: 213-977-0419
  • Fax: 213-250-9416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: KHIEM PV NGUYEN
Title or Position: OWNER
Credential: MD
Phone: 714-775-4400