Healthcare Provider Details

I. General information

NPI: 1508249962
Provider Name (Legal Business Name): WENDY THU NGUYEN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: THU TRANG NGUYEN

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 08/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11942 PARAMOUNT BLVD
DOWNEY CA
90242
US

IV. Provider business mailing address

417 S STATE ST
LOS ANGELES CA
90033-3818
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-6060
  • Fax:
Mailing address:
  • Phone: 714-640-3470
  • Fax: 714-340-3475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number55852
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: