Healthcare Provider Details

I. General information

NPI: 1831396431
Provider Name (Legal Business Name): ANNA NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S ORANGE AVE
FRESNO CA
93702-3463
US

IV. Provider business mailing address

1350 S ORANGE AVE
FRESNO CA
93702-3463
US

V. Phone/Fax

Practice location:
  • Phone: 559-457-5400
  • Fax: 559-457-5490
Mailing address:
  • Phone: 559-457-5400
  • Fax: 559-457-5491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA118937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: