Healthcare Provider Details

I. General information

NPI: 1679810907
Provider Name (Legal Business Name): STEVEN D NGUYEN MPA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12966 EUCLID ST STE 495
GARDEN GROVE CA
92840-9209
US

IV. Provider business mailing address

12912 BROOKHURST ST
GARDEN GROVE CA
92840-4835
US

V. Phone/Fax

Practice location:
  • Phone: 714-461-3687
  • Fax: 714-591-5015
Mailing address:
  • Phone: 714-461-3687
  • Fax: 714-591-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: