Ellison Medical Group Vein Treatment Center

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

ELLISON MEDICAL GROUP VEIN TREATMENT CENTER

Practice address

5330 Carroll Canyon Rd Ste 140
San Diego, CA 92121-3758

Phone

(669) 201-0667

Fax

(818) 616-6046

NPI assigned

Mar 26, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael Nguyen, MDNPI 1730380478

Title

Owner

Phone

(332) 282-5622

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Alexis K Brown

  • Physician Assistant
  • San Diego, CA
  • NPI 1073382081
  Medicare reassignment Care Compare group NPD
• Zaria Francis

  • Medical Physician Assistant
  • Santa Maria, CA
  • NPI 1871325290
  Medicare reassignment Care Compare group NPD
• Joshua Titus Kindelan, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • San Diego, CA
  • NPI 1538222104
  Medicare reassignment Care Compare group NPD
• Walter J Lech, M.D.

  • Phlebology Physician
  • San Jose, CA
  • NPI 1215073853
  Medicare reassignment Care Compare group NPD
• Kimberly Christine McFarland, M.D.

  • Vascular & Interventional Radiology Physician
  • Temecula, CA
  • NPI 1609135946
  Medicare reassignment Care Compare group NPD
• Sanford I Davis, MD

  • Diagnostic Radiology Physician
  • Bradenton, FL
  • NPI 1558472233

  CA

  Medicare reassignment Care Compare group NPD
• Farshid Etaee, MD

  • Internal Medicine Physician
  • New Haven, CT
  • NPI 1437645108

  CA, Specialist

  Medicare reassignment Care Compare group NPD
• Hyun Min Jang

  • Physician Assistant
  • Albany, NY
  • NPI 1487365714

  CA

  Medicare reassignment Care Compare group NPD
• Michael Nguyen, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Coral Gables, FL
  • NPI 1730380478

  CA

  Medicare reassignment NPD Authorized official
• Akash Mehta, DO

  • Emergency Medicine Physician
  • Encino, CA
  • NPI 1710242128
  Medicare reassignment Care Compare group NPD (past)
• Niveditha Vilasagar, M.D.

  • Pediatric Critical Care Medicine Physician
  • Arcadia, CA
  • NPI 1831355320
  Medicare reassignment Care Compare group NPD (past)
• Jessica Montoya, NP

  • Adult Health Nurse Practitioner
  • Temecula, CA
  • NPI 1730722034
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782259200000",
    "number": "1033614706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 MADISON AVE STE 141",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100162817",
            "telephone_number": "669-201-0667",
            "fax_number": "818-616-6046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5330 CARROLL CANYON RD STE 140",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921213758",
            "telephone_number": "669-201-0667",
            "fax_number": "818-616-6046"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1117 Route 46 Ste 205",
            "address_purpose": "LOCATION",
            "city": "Clifton",
            "state": "NJ",
            "postal_code": "070132450",
            "country_code": "US",
            "telephone_number": "669-201-0667",
            "fax_number": "818-616-6046",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ELLISON MEDICAL GROUP VEIN TREATMENT CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-26",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A",
        "authorized_official_last_name": "NGUYEN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "332-282-5622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "A108285",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nolan Andrew Ellis, DIVE IDC
• Ronald J Ellis, M.D., PH.D.
• Stephanie Ellis, PHARMD
• Tessa Ellis, RDN
• Vivian E. Ellis, M.D.
• Douglas Jules Ellison, M.D.
• George W Ellison, M.D
• Kiyenna Ellison
• Theresa Kuni Ellithorpe, L.AC.
• Megan Ellmaker

• Specialist in San Diego, CA
• Providers in San Diego, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.