Healthcare Provider Details

I. General information

NPI: 1396754610
Provider Name (Legal Business Name): TRUNG NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1508 GARCES HWY STE 1
DELANO CA
93215-3607
US

IV. Provider business mailing address

1430 TRUXTUN AVE STE 400 CLINICA SIERRA VISTA PO BOX 1559
BAKERSFIELD CA
93301-5220
US

V. Phone/Fax

Practice location:
  • Phone: 661-725-4780
  • Fax: 661-725-1048
Mailing address:
  • Phone: 661-635-3050
  • Fax: 661-869-1503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A9588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: