Healthcare Provider Details

I. General information

NPI: 1265492771
Provider Name (Legal Business Name): JESSICA CHI NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N 5TH AVE 201
ARCADIA CA
91006-3710
US

IV. Provider business mailing address

51 N 5TH AVE STE 201
ARCADIA CA
91006-3711
US

V. Phone/Fax

Practice location:
  • Phone: 626-676-6273
  • Fax:
Mailing address:
  • Phone: 626-358-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA69259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: