Mitchell Baolong Nguyen

Primary specialty

Physical Rehabilitation Occupational TherapistTaxonomy code 225XP0019X

Practice address

1007 Pitman Ave
Glendale, CA 91202-2816

Phone

(818) 633-6959

NPI assigned

Dec 31, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1546214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637107200000",
    "number": "1619449675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1007 PITMAN AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912022816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 PITMAN AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912022816",
            "telephone_number": "818-633-6959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NGUYEN",
        "first_name": "MITCHELL",
        "middle_name": "BAOLONG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-12-31",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225XP0019X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Physical Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4760 W Sunset Blvd",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900276063",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Janie Nguyen, AUD
• Linda Nguyen, DDS
• Lisa Bui Nguyen, DDS
• Lyna Thuy Nguyen, RPH
• Matthew Hieu Nguyen, D.P.M.
• Nathalie Nguyen, D.O.
• Sandy Nguyen, O.D.
• Thanh The Nguyen, D.O
• Tiffany Nguyen
• Van Nguyen, PHARMD

• Physical Rehabilitation Occupational Therapist in Glendale, CA
• Providers in Glendale, CA by specialty
• Physical Rehabilitation Occupational Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.