MEDICARE: HENRY VAN GIESON MD

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	207RC0000X	Cardiovascular Disease Physician	G74156	CA
2	207RI0011X	Interventional Cardiology Physician	G74156	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ73964Z	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1669403549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY VAN GIESON MD

Provider Business Mailing Address
First Line	:	2898 LINDEN AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806
Country	:	US
Telephone Number	:	562-595-8671
Fax Number	:	562-490-2015

Provider Business Practice Location Address
First Line	:	2898 LINDEN AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806
Country	:	US
Telephone Number	:	562-595-8671
Fax Number	:	562-490-2015

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	11/05/2015

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