Provider Demographics
NPI:1255684155
Name:ASSOCIATED DIGNITY MEDICAL GROUP PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ASSOCIATED DIGNITY MEDICAL GROUP PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MINH
Authorized Official - Middle Name:N
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-947-8600
Mailing Address - Street 1:10855 BUSINESS CENTER DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-5252
Mailing Address - Country:US
Mailing Address - Phone:714-947-8600
Mailing Address - Fax:
Practice Address - Street 1:10855 BUSINESS CENTER DR
Practice Address - Street 2:SUITE C
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-5252
Practice Address - Country:US
Practice Address - Phone:714-947-8600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3471612OtherCORPORATION NUMBER