Individual
OVI MOAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9815 LAS TUNAS DR, TEMPLE CITY, CA 91780-2209
(626) 285-7158
(626) 285-9392
Mailing address
9815 LAS TUNAS DR, TEMPLE CITY, CA 91780-2209
(626) 285-7158
(626) 285-9392
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A35730
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A357300
—
CA
Enumeration date
10/16/2006
Last updated
09/24/2023
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