Provider Demographics
NPI:1396399598
Name:INNOVATIVE WELLNESS MEDICAL, INC.
Entity Type:Organization
Organization Name:INNOVATIVE WELLNESS MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:QUYNH
Authorized Official - Last Name:DANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:714-336-7536
Mailing Address - Street 1:PO BOX 164
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-0164
Mailing Address - Country:US
Mailing Address - Phone:323-504-2313
Mailing Address - Fax:
Practice Address - Street 1:11525 BROOKSHIRE AVE STE 205
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4982
Practice Address - Country:US
Practice Address - Phone:323-504-2313
Practice Address - Fax:714-369-2641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-26
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty