Organization
M. BUSSARAKUM, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MINGQUAN BUSSARAKUM M.D. (PRESIDENT)
(213) 483-0500
Entity
Organization
Contact information
Practice address
201 S ALVARADO ST, SUITE 603, LOS ANGELES, CA 90057-2320
(213) 483-0500
(213) 483-3767
Mailing address
201 S ALVARADO ST, SUITE 603, LOS ANGELES, CA 90057-2320
(213) 483-0500
(213) 483-3767
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
A30882
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A308820
—
CA
Enumeration date
03/30/2007
Last updated
03/12/2009
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