Healthcare Provider Details

I. General information

NPI: 1548274996
Provider Name (Legal Business Name): AMY NGOC NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 N HARBOR BLVD STE 205
FULLERTON CA
92835-2609
US

IV. Provider business mailing address

2720 N HARBOR BLVD STE 205
FULLERTON CA
92835-2974
US

V. Phone/Fax

Practice location:
  • Phone: 714-882-5525
  • Fax: 714-882-5078
Mailing address:
  • Phone: 714-882-5525
  • Fax: 714-882-5078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA80879
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA80879
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: