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General NPI Number Information
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NPI Number | 1811006869
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Entity Type | Organization
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Legal Business Name | LA MAGNOLIA MEDICAL GROUP
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 06/14/2013
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Provider Practice Location Address
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Address Line | 14571 MAGNOLIA ST. #210
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City | WESTMINSTER
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State | CA
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Zip | 92683
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Country | US
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Telephone | 714-894-3103
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Fax | 714-894-6264
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Provider Business Mailing Address
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Address Line | 14571 MAGNOLIA ST. #210
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City | WESTMINSTER
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State | CA
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Zip | 92683
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Country | US
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Telephone | 714-894-3103
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Fax | 714-894-6264
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. YENCHI NGUYEN PHUC
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Credential | MD
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Telephone | 714-894-3103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A40020
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | G63064
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License Number State | CA
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