Provider Demographics
NPI:1558754424
Name:AUNGKHIN PSYCHIATRY MEDICAL GROUP
Entity Type:Organization
Organization Name:AUNGKHIN PSYCHIATRY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:714-774-5915
Mailing Address - Street 1:1673 W BROADWAY STE 6
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-1109
Mailing Address - Country:US
Mailing Address - Phone:714-774-5915
Mailing Address - Fax:714-774-8095
Practice Address - Street 1:1673 W BROADWAY STE 6
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1109
Practice Address - Country:US
Practice Address - Phone:714-774-5915
Practice Address - Fax:714-774-8095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9871363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA123377OtherPTAN ANGELA DESAI / CA123377
CACA123377OtherPTAN ANGELA DESAI / CA123377