Healthcare Provider Details

I. General information

NPI: 1992828511
Provider Name (Legal Business Name): THOM TAN NGUYEN L. AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5324 E 2ND ST
LONG BEACH CA
90803-5332
US

IV. Provider business mailing address

4803 LAKEWOOD BLVD
LAKEWOOD CA
90712-3513
US

V. Phone/Fax

Practice location:
  • Phone: 562-433-2443
  • Fax:
Mailing address:
  • Phone: 562-420-2614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 4997
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: