Healthcare Provider Details

I. General information

NPI: 1841234952
Provider Name (Legal Business Name): SI VAN NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12601 GARDEN GROVE BLVD PATHOLOGY DEPT.
GARDEN GROVE CA
92843-1908
US

IV. Provider business mailing address

20001 S RANCHO WAY
RANCHO DOMINGUEZ CA
90220-6318
US

V. Phone/Fax

Practice location:
  • Phone: 949-874-0827
  • Fax: 310-698-7054
Mailing address:
  • Phone: 310-225-3244
  • Fax: 310-698-7040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA48904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: