Provider Demographics
NPI:1013785005
Name:CA VEIN MEDICAL PC
Entity Type:Organization
Organization Name:CA VEIN MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:669-201-0667
Mailing Address - Street 1:244 MADISON AVE # 1120
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2817
Mailing Address - Country:US
Mailing Address - Phone:669-201-0667
Mailing Address - Fax:
Practice Address - Street 1:15706 POMERADO RD STE N202
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2067
Practice Address - Country:US
Practice Address - Phone:669-201-0667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty