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Organization

BR LAB AND RADIOLOGY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. BAO THAI NGUYEN MD (MEDICAL DIRECTOR)
(424) 488-0500
Entity
Organization

Contact information

Practice address
555 PIER AVE, STE #1, HERMOSA BEACH, CA 90254-3839
(424) 488-0500
Mailing address
555 PIER AVE, STE #1, HERMOSA BEACH, CA 90254-3839
(424) 488-0500

Taxonomy

Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
A95636
CA

Other

Enumeration date
02/27/2015
Last updated
02/27/2015
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