Provider Demographics
NPI:1013196195
Name:H MICHAEL MYNATT M D INC
Entity Type:Organization
Organization Name:H MICHAEL MYNATT M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIANE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DEYOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-660-7575
Mailing Address - Street 1:157 S WINDSOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-3817
Mailing Address - Country:US
Mailing Address - Phone:323-660-7575
Mailing Address - Fax:323-931-1188
Practice Address - Street 1:1300 N VERMONT AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6061
Practice Address - Country:US
Practice Address - Phone:323-913-4300
Practice Address - Fax:323-913-4301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28022207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1326100207OtherINDIVIDUAL NPI
CA1326100207Medicaid
CAA89470Medicare UPIN