Healthcare Provider Details

I. General information

NPI: 1356083927
Provider Name (Legal Business Name): TIFFANY THANH NGUYEN MD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 BREA CANYON RD STE 330
DIAMOND BAR CA
91789-3095
US

IV. Provider business mailing address

888 BREA CANYON RD STE 330
DIAMOND BAR CA
91789-3095
US

V. Phone/Fax

Practice location:
  • Phone: 909-594-3382
  • Fax: 626-667-7633
Mailing address:
  • Phone: 909-594-3382
  • Fax: 626-667-7633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA188752
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: