Healthcare Provider Details

I. General information

NPI: 1609117530
Provider Name (Legal Business Name): NAM SI DONG, M.D.,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 03/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14082 MAGNOLIA ST STE 111
WESTMINSTER CA
92683-4764
US

IV. Provider business mailing address

14082 MAGNOLIA ST STE 111
WESTMINSTER CA
92683-4764
US

V. Phone/Fax

Practice location:
  • Phone: 714-898-0424
  • Fax: 714-459-7325
Mailing address:
  • Phone: 714-898-0424
  • Fax: 714-459-7325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NAM SI DONG
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 714-898-0424