Healthcare Provider Details

I. General information

NPI: 1558699827
Provider Name (Legal Business Name): BENJAMIN NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2009
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE 3RD FLOOR ANESTHESIA ADMINISTRATION
FONTANA CA
92335-6720
US

IV. Provider business mailing address

9961 SIERRA AVE 3RD FLOOR ANESTHESIA ADMINISTRATION
FONTANA CA
92335-6720
US

V. Phone/Fax

Practice location:
  • Phone: 909-302-4857
  • Fax:
Mailing address:
  • Phone: 909-302-4857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA110128
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA 110128
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: