Provider Demographics
NPI:1508265729
Name:PACIFIC HEALTH MSO, INC
Entity Type:Organization
Organization Name:PACIFIC HEALTH MSO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-641-2119
Mailing Address - Street 1:820 S GARFIELD AVE
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5838
Mailing Address - Country:US
Mailing Address - Phone:626-782-6202
Mailing Address - Fax:626-249-5392
Practice Address - Street 1:820 S GARFIELD AVE
Practice Address - Street 2:SUITE 201A
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5838
Practice Address - Country:US
Practice Address - Phone:626-782-6202
Practice Address - Fax:626-249-5392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization