Healthcare Provider Details

I. General information

NPI: 1326036708
Provider Name (Legal Business Name): MICHAEL V. NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 BROOKSHIRE AVE
DOWNEY CA
90241-4917
US

IV. Provider business mailing address

210 N TUSTIN AVE
SANTA ANA CA
92705-3807
US

V. Phone/Fax

Practice location:
  • Phone: 562-869-0500
  • Fax: 562-869-2309
Mailing address:
  • Phone: 714-347-1000
  • Fax: 714-647-1245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A8659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: