Healthcare Provider Details

I. General information

NPI: 1003910282
Provider Name (Legal Business Name): TRUNG BUU NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 10/13/2021
Certification Date: 10/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E. 7TH STREET LONG BEACH CA90822 9400 E ROSECRANS AVE
BELLFLOWER CA
90706
US

IV. Provider business mailing address

393 E WALNUT ST FL ST3
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax: 562-657-4970
Mailing address:
  • Phone: 562-657-4970
  • Fax: 562-657-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA035613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: