Healthcare Provider Details

I. General information

NPI: 1669010260
Provider Name (Legal Business Name): VAN NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2019
Last Update Date: 08/29/2026
Certification Date: 08/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2760 ATLANTIC AVE
LONG BEACH CA
90806-2755
US

IV. Provider business mailing address

2760 ATLANTIC AVE
LONG BEACH CA
90806-2755
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-6666
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: