Healthcare Provider Details

I. General information

NPI: 1194308874
Provider Name (Legal Business Name): MICHAEL KIEN NINH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72057 HIGHWAY 111
RANCHO MIRAGE CA
92270-4927
US

IV. Provider business mailing address

72057 HIGHWAY 111
RANCHO MIRAGE CA
92270-4927
US

V. Phone/Fax

Practice location:
  • Phone: 760-619-3053
  • Fax:
Mailing address:
  • Phone: 760-619-3053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA191337
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: