Healthcare Provider Details

I. General information

NPI: 1326551219
Provider Name (Legal Business Name): ANDY KHUONG NGUYEN FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2017
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41889 FLORIDA AVE
HEMET CA
92544-5042
US

IV. Provider business mailing address

370 RANDY LN
PERRIS CA
92571-2967
US

V. Phone/Fax

Practice location:
  • Phone: 951-652-8700
  • Fax:
Mailing address:
  • Phone: 951-581-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95007843
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number821380
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: