Healthcare Provider Details

I. General information

NPI: 1891444725
Provider Name (Legal Business Name): HIEU TRUNG NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2022
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CORPORATE DR STE 260
LADERA RANCH CA
92694-2180
US

IV. Provider business mailing address

333 CORPORATE DR STE 260
LADERA RANCH CA
92694-2180
US

V. Phone/Fax

Practice location:
  • Phone: 949-768-2988
  • Fax: 949-768-2980
Mailing address:
  • Phone: 949-768-2988
  • Fax: 949-768-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD61588870
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA206241
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: