Provider Demographics
NPI:1497759104
Name:INTERNAL MEDICINE AND NEPHROLOGY MED. GROUP INC.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE AND NEPHROLOGY MED. GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:VINH
Authorized Official - Middle Name:T
Authorized Official - Last Name:CAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-325-4517
Mailing Address - Street 1:3291 SKYPARK DR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5004
Mailing Address - Country:US
Mailing Address - Phone:310-325-4517
Mailing Address - Fax:310-325-1144
Practice Address - Street 1:3291 SKYPARK DR
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5004
Practice Address - Country:US
Practice Address - Phone:310-325-4517
Practice Address - Fax:310-325-1144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133VN1005X
CABUS-0041314207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, RenalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ72355ZMedicaid
CAZZZ72355ZMedicaid