Organization
ELLISON MEDICAL GROUP VEIN TREATMENT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL NGUYEN MD (OWNER)
(305) 962-5239
Entity
Organization
Contact information
Practice address
5330 CARROLL CANYON RD STE 140, SAN DIEGO, CA 92121-3758
(669) 201-0667
(818) 616-6046
Mailing address
244 MADISON AVE STE 141, NEW YORK, NY 10016-2817
(669) 201-0667
(818) 616-6046
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A108285
LICENSE
CA
Enumeration date
03/26/2018
Last updated
04/13/2026
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