Healthcare Provider Details

I. General information

NPI: 1013250497
Provider Name (Legal Business Name): VINA NGUYEN M. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17360 BROOKHURST ST
FOUNTAIN VALLEY CA
92708
US

IV. Provider business mailing address

17360 BROOKHURST STREET ATTN: CREDENTIALING DEPARTMENT
FOUNTAIN VALLEY CA
92708-3720
US

V. Phone/Fax

Practice location:
  • Phone: 714-665-1797
  • Fax:
Mailing address:
  • Phone: 714-665-1797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA145552
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA145552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: