Provider Demographics
NPI:1831973049
Name:MSO, INC. OF SOUTHERN CALIFORNIA
Entity type:Organization
Organization Name:MSO, INC. OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-399-8996
Mailing Address - Street 1:17622 ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-5728
Mailing Address - Country:US
Mailing Address - Phone:626-656-2370
Mailing Address - Fax:866-627-3093
Practice Address - Street 1:17622 ARMSTRONG AVE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-5728
Practice Address - Country:US
Practice Address - Phone:626-656-2370
Practice Address - Fax:866-627-3093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare