Healthcare Provider Details

I. General information

NPI: 1962047365
Provider Name (Legal Business Name): DANIEL TRAN-HOA NGUYEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2019
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11190 WARNER AVE STE 300
FOUNTAIN VALLEY CA
92708-4045
US

IV. Provider business mailing address

11190 WARNER AVE STE 300
FOUNTAIN VALLEY CA
92708-4045
US

V. Phone/Fax

Practice location:
  • Phone: 714-241-7000
  • Fax: 714-241-7003
Mailing address:
  • Phone: 714-241-7000
  • Fax: 714-241-7003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA57491
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA57491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: