Healthcare Provider Details

I. General information

NPI: 1417877150
Provider Name (Legal Business Name): KHOA NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7755 CENTER AVE STE 1100
HUNTINGTON BEACH CA
92647-3091
US

IV. Provider business mailing address

636 S WESTCHESTER DR
ANAHEIM CA
92804-3028
US

V. Phone/Fax

Practice location:
  • Phone: 714-251-4183
  • Fax: 714-782-6901
Mailing address:
  • Phone: 714-251-4183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: