Provider Demographics
NPI:1386867042
Name:TSERENDORJ, ENKHBAYAR (L AC)
Entity Type:Individual
Prefix:DR
First Name:ENKHBAYAR
Middle Name:
Last Name:TSERENDORJ
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 S LAKE ST
Mailing Address - Street 2:#103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-3649
Mailing Address - Country:US
Mailing Address - Phone:213-479-4680
Mailing Address - Fax:213-383-1499
Practice Address - Street 1:23215 HAWTHORNE BLVD
Practice Address - Street 2:D
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3772
Practice Address - Country:US
Practice Address - Phone:310-791-5258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist