1922232206 NPI number — DR. TRUONGSON XUAN NGUYEN M.D.

Table of content: DR. TRUONGSON XUAN NGUYEN M.D. (NPI 1922232206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922232206 NPI number — DR. TRUONGSON XUAN NGUYEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NGUYEN
Provider First Name:
TRUONGSON
Provider Middle Name:
XUAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NGUYEN
Provider Other First Name:
SONNY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1922232206
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1310 W STEWART DR
Provider Second Line Business Mailing Address:
SUITE 410
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-3854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-639-9401
Provider Business Mailing Address Fax Number:
714-639-7095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1310 W STEWART DR
Provider Second Line Business Practice Location Address:
SUITE 410
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868-3854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-639-9401
Provider Business Practice Location Address Fax Number:
714-639-7095
Provider Enumeration Date:
05/14/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208M00000X , with the licence number:  A101982 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A101982 . This is a "STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W1514 . This is a "MEDICARE PTAN - TYPE 2" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912919804 . This is a "NPI - TYPE 2" identifier . This identifiers is of the category "OTHER".
  • Identifier: GR0003350 . This is a "MEDICAID - GROUP PROVIDER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com