Healthcare Provider Details

I. General information

NPI: 1194216283
Provider Name (Legal Business Name): QUY TU NGUYEN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2018
Last Update Date: 05/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N RODEO DR PH 1
BEVERLY HILLS CA
90210-4531
US

IV. Provider business mailing address

421 N RODEO DR PH 1
BEVERLY HILLS CA
90210-4531
US

V. Phone/Fax

Practice location:
  • Phone: 310-432-6640
  • Fax: 310-432-6647
Mailing address:
  • Phone: 310-432-6640
  • Fax: 310-432-6647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA131609
License Number StateCA

VIII. Authorized Official

Name: QUY T NGUYEN
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 310-432-6640