Healthcare Provider Details

I. General information

NPI: 1336201961
Provider Name (Legal Business Name): LOC NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 WARNER AVE STE #202
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

11100 WARNER AVE STE #202
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 714-979-4499
  • Fax: 714-979-4466
Mailing address:
  • Phone: 714-979-4499
  • Fax: 714-979-4466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA35330
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: