Provider Demographics
NPI:1851390751
Name:PARDEE, MYANH N (MD)
Entity type:Individual
Prefix:
First Name:MYANH
Middle Name:N
Last Name:PARDEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MYANH
Other - Middle Name:C
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1809 WASHINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4703
Mailing Address - Country:US
Mailing Address - Phone:310-708-6383
Mailing Address - Fax:562-429-8070
Practice Address - Street 1:433 N CAMDEN DR STE 610
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4416
Practice Address - Country:US
Practice Address - Phone:310-708-6383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83621207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A836210OtherMEDI CAL #
CAH99610Medicare UPIN