Healthcare Provider Details

I. General information

NPI: 1871339499
Provider Name (Legal Business Name): TIFFANY DIEP NGUYEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 MAYFLOWER AVE
ARCADIA CA
91006-5035
US

IV. Provider business mailing address

2604 MAYFLOWER AVE
ARCADIA CA
91006-5035
US

V. Phone/Fax

Practice location:
  • Phone: 626-254-3256
  • Fax:
Mailing address:
  • Phone: 626-254-3256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: