Healthcare Provider Details

I. General information

NPI: 1780929109
Provider Name (Legal Business Name): QUYNH-UYEN NGUYEN SMITH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2012
Last Update Date: 06/08/2022
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17100 EUCLID STREET PICU/PEDS DEPARTMENT
FOUNTAIN VALLEY CA
92708-9270
US

IV. Provider business mailing address

17100 EUCLID STREET PICU/PEDS DEPARTMENT
FOUNTAIN VALLEY CA
92708
US

V. Phone/Fax

Practice location:
  • Phone: 714-966-7253
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML60470161
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA148888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: