Provider Demographics
NPI:1255366837
Name:AUNG, MYO (MD)
Entity type:Individual
Prefix:DR
First Name:MYO
Middle Name:
Last Name:AUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28920 FOUNTAINWOOD ST
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1726
Mailing Address - Country:US
Mailing Address - Phone:818-519-3498
Mailing Address - Fax:
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:825
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2320
Practice Address - Country:US
Practice Address - Phone:213-484-1300
Practice Address - Fax:213-484-1313
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44476174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A444760Medicaid
CA00A444760Medicaid
CAA44476Medicare ID - Type Unspecified