Healthcare Provider Details

I. General information

NPI: 1477897452
Provider Name (Legal Business Name): THANH H NGUYEN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17822 BEACH BLVD STE 400
HUNTINGTON BEACH CA
92647-7510
US

IV. Provider business mailing address

11381 WEST ST
GARDEN GROVE CA
92840-1751
US

V. Phone/Fax

Practice location:
  • Phone: 714-332-7016
  • Fax:
Mailing address:
  • Phone: 951-756-6252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number22398
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP 22398
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: