Healthcare Provider Details

I. General information

NPI: 1972161255
Provider Name (Legal Business Name): HOANG DUC NGUYEN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22110 ROSCOE BLVD STE 100
CANOGA PARK CA
91304-3875
US

IV. Provider business mailing address

22110 ROSCOE BLVD STE 100
CANOGA PARK CA
91304-3875
US

V. Phone/Fax

Practice location:
  • Phone: 818-481-0118
  • Fax: 818-584-8926
Mailing address:
  • Phone: 818-481-0118
  • Fax: 818-584-8926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. HOANG DUC NGUYEN
Title or Position: CEO
Credential: MD
Phone: 818-481-0118