MEDICARE: MYANH N PARDEE 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	207R00000X	Internal Medicine Physician	A83621	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A836210	OTHER	CA	MEDI CAL #

General Provider Information

NPI Number	:	1851390751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYANH N PARDEE MD

Provider Business Mailing Address
First Line	:	1809 WASHINGTON WAY
Second Line	:
City	:	VENICE
State	:	CA
Zip	:	90291-4703
Country	:	US
Telephone Number	:	310-708-6383
Fax Number	:	562-429-8070

Provider Business Practice Location Address
First Line	:	433 N CAMDEN DR STE 610
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4416
Country	:	US
Telephone Number	:	310-708-6383
Fax Number	:

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

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	07/29/2024

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