Provider Demographics
NPI:1831334010
Name:EDGAR ALLAN R MUSNGI, M.D. INC.
Entity type:Organization
Organization Name:EDGAR ALLAN R MUSNGI, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:ALLAN R
Authorized Official - Last Name:MUSNGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:310-301-0015
Mailing Address - Street 1:4644 LINCOLN BLVD STE 540
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6391
Mailing Address - Country:US
Mailing Address - Phone:310-301-0015
Mailing Address - Fax:310-301-4882
Practice Address - Street 1:4644 LINCOLN BLVD STE 540
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-6391
Practice Address - Country:US
Practice Address - Phone:310-301-0015
Practice Address - Fax:310-301-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54118174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A541180Medicaid
CAG70424Medicare UPIN
CAA54118Medicare PIN