Provider Demographics
NPI:1588722144
Name:HARDY, MIEN (MD)
Entity type:Individual
Prefix:
First Name:MIEN
Middle Name:
Last Name:HARDY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 E HARDY ST
Mailing Address - Street 2:PATHOLOGY DEPARTMENT
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4011
Mailing Address - Country:US
Mailing Address - Phone:310-680-8391
Mailing Address - Fax:310-412-4501
Practice Address - Street 1:555 E HARDY ST
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4011
Practice Address - Country:US
Practice Address - Phone:310-680-8391
Practice Address - Fax:310-412-4501
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38125207ZC0500X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Not Answered207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA38125AMedicare ID - Type Unspecified
CAWA38125BMedicare ID - Type Unspecified