MEDICARE: IMPERIAL MEDICAL HEALTH CARE GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1215229315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL MEDICAL HEALTH CARE GROUP, INC

Provider Business Mailing Address
First Line	:	5825 IMPERIAL AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-4118
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5825 IMPERIAL AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92114-4118
Country	:	US
Telephone Number	:	619-262-1899
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. ANHVU HOANG NGUYEN
Credential	:
Telephone Number	:	949-232-4790

Provider Enumeration Date	:	05/06/2011
Last Update Date	:	05/06/2011

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