Healthcare Provider Details

I. General information

NPI: 1427241975
Provider Name (Legal Business Name): MARIELLE HANH NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2007
Last Update Date: 11/01/2021
Certification Date: 11/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 N LAKEVIEW AVE
ANAHEIM CA
92807-3028
US

IV. Provider business mailing address

441 N LAKEVIEW AVE
ANAHEIM CA
92807-3028
US

V. Phone/Fax

Practice location:
  • Phone: 714-279-5616
  • Fax:
Mailing address:
  • Phone: 714-279-5616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA77844
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA77844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: