Healthcare Provider Details

I. General information

NPI: 1619409190
Provider Name (Legal Business Name): ANGELA WENTIN NIEH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 05/10/2025
Certification Date: 05/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE PLASTIC SURGERY, 2ND FLOOR, STATION 2E
SACRAMENTO CA
95825
US

IV. Provider business mailing address

2025 MORSE AVE PLASTIC SURGERY, 2ND FLOOR, STATION 2E
SACRAMENTO CA
95825
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-5515
  • Fax:
Mailing address:
  • Phone: 916-973-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA157330
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA157330
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036160697
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: