Physician Compare National (NPI:1376707711)

HEALTHCARE PROVIDER: MYTIEN GOLDBERG M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1376707711
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1254524192
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20101022001168
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GOLDBERG
	Individual professional last name
Provider First Name	MYTIEN
	Individual professional first name
Provider Middle Name	T
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	STANFORD UNIVERSITY SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2001
	Individual professional's medical school graduation year
Primary Specialty	PLASTIC AND RECONSTRUCTIVE SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	HAND SURGERY
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	HAND SURGERY
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	426 N LINDEN DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 236
	Group Practice or individual's line 2 address
City	BEVERLY HILLS
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	902122200
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050376
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	LAC/HARBOR-UCLA MED CENTER
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	M