Healthcare Provider Details

I. General information

NPI: 1003279480
Provider Name (Legal Business Name): ANHTHU NGOC NGUYEN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2016
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10776 LOTUS DR
GARDEN GROVE CA
92843-4963
US

IV. Provider business mailing address

10776 LOTUS DR
GARDEN GROVE CA
92843-4963
US

V. Phone/Fax

Practice location:
  • Phone: 714-823-5437
  • Fax: 714-464-4606
Mailing address:
  • Phone: 714-823-5437
  • Fax: 714-464-4606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: ANHTHU NGOG NGUYEN
Title or Position: OWNER
Credential: MD
Phone: 714-823-5437