Healthcare Provider Details

I. General information

NPI: 1699113829
Provider Name (Legal Business Name): TAMMY TAM NGUYEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8767 WILSHIRE BLVD FL 3
BEVERLY HILLS CA
90211-2714
US

IV. Provider business mailing address

4140 W 190TH ST FL 2
TORRANCE CA
90504-5513
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-6031
  • Fax:
Mailing address:
  • Phone: 310-385-6031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSL0952
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: