Provider Demographics
NPI:1558766600
Name:CHILDREN AND ADULT MEDICAL GROUP
Entity Type:Organization
Organization Name:CHILDREN AND ADULT MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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 1:9246 VALLEY BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1922
Mailing Address - Country:US
Mailing Address - Phone:626-571-6908
Mailing Address - Fax:626-571-7732
Practice Address - Street 1:9246 VALLEY BLVD STE A
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1922
Practice Address - Country:US
Practice Address - Phone:626-571-6908
Practice Address - Fax:626-571-7732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG86422Medicare UPIN