Healthcare Provider Details

I. General information

NPI: 1841382181
Provider Name (Legal Business Name): PROF. CONG TAM NGOC NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TAM NGUYEN

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 IMPERIAL HWY
DOWNEY CA
90242-2813
US

IV. Provider business mailing address

9300 IMPERIAL HWY
DOWNEY CA
90242-2813
US

V. Phone/Fax

Practice location:
  • Phone: 562-922-7488
  • Fax:
Mailing address:
  • Phone: 562-922-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: