Organization
HUNG ANH BA NGUYEN MD INCORPORTED
Active
Parent organization
MEDVANTX, INC
Other names
Zinfandel Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
2001 ZINFANDEL DR, SUITE B2, RANCHO CORDOVA, CA 95670-4265
(916) 369-8682
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
A96119
CA
Other
Enumeration date
10/22/2014
Last updated
10/22/2014
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