Healthcare Provider Details

I. General information

NPI: 1922925874
Provider Name (Legal Business Name): THOMAS NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8109 COOPER LN
GARDENA CA
90248-1410
US

IV. Provider business mailing address

8109 COOPER LN
GARDENA CA
90248-1410
US

V. Phone/Fax

Practice location:
  • Phone: 310-347-5452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95040242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: