Healthcare Provider Details

I. General information

NPI: 1598384166
Provider Name (Legal Business Name): NINA MAITHI LONG DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 W THOUSAND OAKS BLVD STE 300
THOUSAND OAKS CA
91360-4460
US

IV. Provider business mailing address

1000 W CARSON ST # 492
TORRANCE CA
90502-2059
US

V. Phone/Fax

Practice location:
  • Phone: 805-418-9100
  • Fax:
Mailing address:
  • Phone: 310-222-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number20A20140
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: