1578523049 NPI number — THANH-VAN NGOC NGUYEN MD A PROFESSIONAL MEDICAL CORPORATION

Table of content: (NPI 1578523049)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578523049 NPI number — THANH-VAN NGOC NGUYEN MD A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THANH-VAN NGOC NGUYEN MD A PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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NPI Number Information

NPI Number:
1578523049
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10760 WARNER AVE
Provider Second Line Business Mailing Address:
201
Provider Business Mailing Address City Name:
FOUNTAIN VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92708-3845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-593-5356
Provider Business Mailing Address Fax Number:
714-593-5366

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10760 WARNER AVE
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
FOUNTAIN VALLEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92708-3845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-593-5356
Provider Business Practice Location Address Fax Number:
714-593-5366
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
THANH-VAN
Authorized Official Middle Name:
NGOC
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
714-593-5356

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  G85166 , 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)





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