Healthcare Provider Details

I. General information

NPI: 1790180065
Provider Name (Legal Business Name): GIOI NGOC SMITH-NGUYEN MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR 206
LA MESA CA
91942-3017
US

IV. Provider business mailing address

8851 CENTER DR 206
LA MESA CA
91942-3017
US

V. Phone/Fax

Practice location:
  • Phone: 619-589-4100
  • Fax: 619-589-4104
Mailing address:
  • Phone: 619-589-4100
  • Fax: 619-589-4104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG61280
License Number StateCA

VIII. Authorized Official

Name: DR. GIOI NGOC SMITH-NGUYEN
Title or Position: PRESIDENT
Credential: MD
Phone: 619-589-4100