1053655027 NPI number — DUC VAN NGUYEN M.D., INC

Table of content: (NPI 1053655027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053655027 NPI number — DUC VAN NGUYEN M.D., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUC VAN NGUYEN M.D., INC
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:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053655027
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8748 VALLEY BLVD
Provider Second Line Business Mailing Address:
SUITE H
Provider Business Mailing Address City Name:
ROSEMEAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91770-1761
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-288-3306
Provider Business Mailing Address Fax Number:
626-288-9444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8748 VALLEY BLVD
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
ROSEMEAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91770-1761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-288-3306
Provider Business Practice Location Address Fax Number:
626-288-9444
Provider Enumeration Date:
11/15/2012

Additional Information

Authorized Official

Authorized Official Last Name:
NGUYEN
Authorized Official First Name:
DUC
Authorized Official Middle Name:
VAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
626-288-3306

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  C42546 , 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: 00C425461 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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