Healthcare Provider Details

I. General information

NPI: 1144785437
Provider Name (Legal Business Name): HUY C NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 11/21/2025
Certification Date: 11/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

519 CORBIN OAK RDG
GRAYSON GA
30017-7865
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-4061
  • Fax: 760-725-1303
Mailing address:
  • Phone: 404-754-2081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number0101270240
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: