Healthcare Provider Details

I. General information

NPI: 1265022438
Provider Name (Legal Business Name): AMY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24012 CALLE DE LA PLATA STE 150
LAGUNA HILLS CA
92653-3632
US

IV. Provider business mailing address

24012 CALLE DE LA PLATA STE 150
LAGUNA HILLS CA
92653-3632
US

V. Phone/Fax

Practice location:
  • Phone: 949-588-7246
  • Fax:
Mailing address:
  • Phone: 949-588-7246
  • Fax: 866-829-7143

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number59827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: