1184720757 NPI number — DR. TIM THE NGUYEN

Table of content: DR. TIM THE NGUYEN (NPI 1184720757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184720757 NPI number — DR. TIM THE NGUYEN

Organization/Personal Information

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

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:
1184720757
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 N ROSE AVE
Provider Second Line Business Mailing Address:
STE 440
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93030-3790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-278-9000
Provider Business Mailing Address Fax Number:
805-981-7767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1851 HOLSER WALK
Provider Second Line Business Practice Location Address:
STE 217
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93036-2626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-278-9000
Provider Business Practice Location Address Fax Number:
805-981-7767
Provider Enumeration Date:
09/14/2006

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: 213ES0103X , with the licence number:  E3928 , 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: PTEN E3928 . This is a "PTEN E3928" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com