Healthcare Provider Details

I. General information

NPI: 1497830962
Provider Name (Legal Business Name): MICHAEL AUNGKHIN REGISTERED NURSE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3840 MYERS ST 2ND FLR.
RIVERSIDE CA
92503-3614
US

IV. Provider business mailing address

18502 STALLION CREST RD
RIVERSIDE CA
92504-9614
US

V. Phone/Fax

Practice location:
  • Phone: 951-358-7718
  • Fax: 951-358-7720
Mailing address:
  • Phone: 951-536-0585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number756959
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number201773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: