MEDICARE: DR. NATHAN JOSEPH VENGALIL M.D.

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	207N00000X	Dermatology Physician	A196365	CA

General Provider Information

NPI Number	:	1558984146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN JOSEPH VENGALIL M.D.

Provider Business Mailing Address
First Line	:	818 N DOHENY DR APT 307
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-4857
Country	:	US
Telephone Number	:	313-806-2476
Fax Number	:

Provider Business Practice Location Address
First Line	:	8631 W 3RD ST STE 1035
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5964
Country	:	US
Telephone Number	:	310-659-9075
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2020
Last Update Date	:	03/06/2026

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