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General NPI Number Information
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NPI Number | 1326612193
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Entity Type | Organization
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Legal Business Name | ATHENA MEDICAL GROUP OF THE CENTRAL COAST, INC.
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Dates
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Enumeration Date | 05/17/2021
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 515 ALAMEDA AVE STE A
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City | SALINAS
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State | CA
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Zip | 93901-4024
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Country | US
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Telephone | 831-900-5113
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Fax | 831-900-5113
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Provider Business Mailing Address
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Address Line | PO BOX 10627
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City | SALINAS
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State | CA
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Zip | 93912-7627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | WILLIAM KHIEU
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Credential | MD
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Telephone | 831-665-6084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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