Active NPI
Mirou Pich Dom, MD
- Psychiatry Physician
- Long Beach, CA
National Provider Identifier
1588825327
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A104280
- Practice address
- 3224 Daisy Ave
Long Beach, CA 90806-1228 - Phone
- (562) 826-7802
- NPI assigned
- Jun 24, 2008
- Last updated
- Jun 24, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A104280 | CA | Primary |
Addresses
Primary practice location
3224 Daisy Ave
Long Beach, CA 90806-1228
Mailing address
3224 Daisy Ave
Long Beach, CA 90806-1228
Phone (562) 826-7802
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110216001032 | CA | Practitioner - Psychiatry | 7012198559 | Practice locations: Irvine, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A104280 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214265600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1214265600000",
"number": "1588825327",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3224 DAISY AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908061228",
"telephone_number": "562-826-7802"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3224 DAISY AVE",
"city": "LONG BEACH",
"state": "CA",
"postal_code": "908061228",
"telephone_number": "562-826-7802"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOM",
"first_name": "MIROU",
"middle_name": "PICH",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-24",
"last_updated": "2008-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A104280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Long Beach, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.