Provider Demographics
NPI:1225073562
Name:KHIEM PV NGUYEN MD CARDIOLOGY ASSOCIATES MEDICAL GROUP INC
Entity Type:Organization
Organization Name:KHIEM PV NGUYEN MD CARDIOLOGY ASSOCIATES MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KHIEM
Authorized Official - Middle Name:PV
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-775-4400
Mailing Address - Street 1:1245 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 703
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4807
Mailing Address - Country:US
Mailing Address - Phone:213-977-0419
Mailing Address - Fax:213-250-9416
Practice Address - Street 1:850 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-4729
Practice Address - Country:US
Practice Address - Phone:626-282-5541
Practice Address - Fax:626-281-8320
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G573012Medicaid
CAWG57301DMedicare UPIN
CA00G573012Medicaid
CAWG57301DMedicare PIN