Healthcare Provider Details

I. General information

NPI: 1497759104
Provider Name (Legal Business Name): INTERNAL MEDICINE AND NEPHROLOGY MED. GROUP INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3291 SKYPARK DR
TORRANCE CA
90505-5004
US

IV. Provider business mailing address

3291 SKYPARK DR
TORRANCE CA
90505-5004
US

V. Phone/Fax

Practice location:
  • Phone: 310-325-4517
  • Fax: 310-325-1144
Mailing address:
  • Phone: 310-325-4517
  • Fax: 310-325-1144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberBUS-0041314
License Number StateCA

VIII. Authorized Official

Name: DR. VINH T CAM
Title or Position: M.D.
Credential: MD
Phone: 310-325-4517