Healthcare Provider Details

I. General information

NPI: 1760623847
Provider Name (Legal Business Name): TUAN XUAN NGUYEN, MD, A PROF CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14221 N. EUCLID ST SUITE H
GARDEN GROVE CA
92843-4991
US

IV. Provider business mailing address

14221 N. EUCLID ST SUITE H
GARDEN GROVE CA
92843-4991
US

V. Phone/Fax

Practice location:
  • Phone: 714-530-2420
  • Fax: 714-530-2478
Mailing address:
  • Phone: 714-530-2420
  • Fax: 714-530-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA48636
License Number StateCA

VIII. Authorized Official

Name: DR. TUAN XUAN NGUYEN
Title or Position: PRESIDENT
Credential: MD
Phone: 714-530-2420