Healthcare Provider Details

I. General information

NPI: 1871415703
Provider Name (Legal Business Name): ANDY NGUYEN CMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8810 HEWITT PL APT 6
GARDEN GROVE CA
92844-2677
US

IV. Provider business mailing address

8810 HEWITT PL APT 6
GARDEN GROVE CA
92844-2677
US

V. Phone/Fax

Practice location:
  • Phone: 714-350-7708
  • Fax:
Mailing address:
  • Phone: 714-350-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number28169
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: