Provider Demographics
NPI:1497830962
Name:AUNGKHIN, MICHAEL (REGISTERED NURSE)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:AUNGKHIN
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18502 STALLION CREST RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-9614
Mailing Address - Country:US
Mailing Address - Phone:951-536-0585
Mailing Address - Fax:
Practice Address - Street 1:3840 MYERS ST
Practice Address - Street 2:2ND FLR.
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3614
Practice Address - Country:US
Practice Address - Phone:951-358-7718
Practice Address - Fax:951-358-7720
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA201773164X00000X
CA756959163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No164X00000XNursing Service ProvidersLicensed Vocational Nurse