Healthcare Provider Details

I. General information

NPI: 1225899883
Provider Name (Legal Business Name): PHUONG-MY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIA NGUYEN

II. Dates (important events)

Enumeration Date: 01/22/2024
Last Update Date: 05/03/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8970 KNOTT AVE
BUENA PARK CA
90620-4137
US

IV. Provider business mailing address

8970 KNOTT AVE
BUENA PARK CA
90620-4137
US

V. Phone/Fax

Practice location:
  • Phone: 949-760-9222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: