Provider Demographics
NPI:1609809631
Name:INLAND UROLOGY MEDICAL GROUP INC
Entity Type:Organization
Organization Name:INLAND UROLOGY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:L
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-623-3428
Mailing Address - Street 1:210 W BONITA AVE
Mailing Address - Street 2:100
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1865
Mailing Address - Country:US
Mailing Address - Phone:909-623-3428
Mailing Address - Fax:909-622-1923
Practice Address - Street 1:210 W BONITA AVE
Practice Address - Street 2:100
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1865
Practice Address - Country:US
Practice Address - Phone:909-623-3428
Practice Address - Fax:909-622-1923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81615208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G816150Medicaid
CA00A623800Medicaid
CA00A623800Medicaid
CAH37885Medicare UPIN
CAWG81615AMedicare ID - Type UnspecifiedNGUYEN
CAWA62380AMedicare ID - Type UnspecifiedPINEDA
CAH19168Medicare UPIN
CA00A623800Medicaid
CAH37885Medicare UPIN