Healthcare Provider Details

I. General information

NPI: 1902778012
Provider Name (Legal Business Name): ANN KIM NGUYEN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 AZALEA DR
COSTA MESA CA
92626-1795
US

IV. Provider business mailing address

956 AZALEA DR
COSTA MESA CA
92626-1795
US

V. Phone/Fax

Practice location:
  • Phone: 714-336-1053
  • Fax:
Mailing address:
  • Phone: 714-336-1053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number95086847
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: