Healthcare Provider Details

I. General information

NPI: 1063894988
Provider Name (Legal Business Name): CHRISTINA THI NGUYEN PA - C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2015
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 SUPERIOR AVE
COSTA MESA CA
92627-3653
US

IV. Provider business mailing address

9122 ADAMS AVE
HUNTINGTON BEACH CA
92646
US

V. Phone/Fax

Practice location:
  • Phone: 949-270-2100
  • Fax:
Mailing address:
  • Phone: 714-378-0900
  • Fax: 714-378-5166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number52593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: