Provider Demographics
NPI:1881237824
Name:SOUTHERN CALIFORNIA FAMILY MEDICINE CLINIC, INC
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA FAMILY MEDICINE CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-641-2119
Mailing Address - Street 1:709 N HILL ST STE 19
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2352
Mailing Address - Country:US
Mailing Address - Phone:213-537-0816
Mailing Address - Fax:213-537-0812
Practice Address - Street 1:709 N HILL ST STE 19
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2352
Practice Address - Country:US
Practice Address - Phone:213-537-0816
Practice Address - Fax:213-537-0812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty