Provider Demographics
NPI:1548011174
Name:ANDRUGTSANG, MIGSAL LHAMO
Entity type:Individual
Prefix:
First Name:MIGSAL
Middle Name:LHAMO
Last Name:ANDRUGTSANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21601 AVALON BLVD APT 228
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-2349
Mailing Address - Country:US
Mailing Address - Phone:347-761-8490
Mailing Address - Fax:
Practice Address - Street 1:612 E CARSON ST STE 101
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2896
Practice Address - Country:US
Practice Address - Phone:310-469-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111958122300000X
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program