Healthcare Provider Details

I. General information

NPI: 1316941966
Provider Name (Legal Business Name): TRUNG MINH NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11180 WARNER AVE STE 151
FOUNTAIN VALLEY CA
92708-7515
US

IV. Provider business mailing address

11180 WARNER AVE STE 151
FOUNTAIN VALLEY CA
92708-7515
US

V. Phone/Fax

Practice location:
  • Phone: 714-444-0303
  • Fax: 714-444-2047
Mailing address:
  • Phone: 714-444-0303
  • Fax: 714-444-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG079014
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: