| Organization Name: | MEDIZEN MAGNOLIA, LLC |
| NPI Number: | 1700235215 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DAVID T MAI (PRESIDENT) |
| Mailing Address: | 17305 Brookhurst St Fountain Valley |
| State: | CA US |
| Postal Code: | 927083721 |
| Phone Number: | 7149688998 |
| Fax Number: | 7149688628 |
| NPI Enumeration Date: | 06/06/2016 |
| NPI Last Update Date: | 06/06/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085B0100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Body Imaging |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Body Imaging. |