Provider Demographics
NPI:1992807721
Name:MUY, MADINETH (MD)
Entity type:Individual
Prefix:
First Name:MADINETH
Middle Name:
Last Name:MUY
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 1:22621 LAKE FOREST DR STE D1
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-1792
Mailing Address - Country:US
Mailing Address - Phone:949-242-6902
Mailing Address - Fax:949-372-3544
Practice Address - Street 1:22621 LAKE FOREST DR STE D1
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-1792
Practice Address - Country:US
Practice Address - Phone:949-242-6902
Practice Address - Fax:949-372-3544
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A739720Medicaid
CA00A739720Medicaid
CAGV936ZMedicare PIN
H72042Medicare UPIN