Healthcare Provider Details

I. General information

NPI: 1134212962
Provider Name (Legal Business Name): LOUIE HOANG NGUYEN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 ATLANTIC AVE STE 180
LONG BEACH CA
90806-1714
US

IV. Provider business mailing address

3858 W CARSON ST STE 121
TORRANCE CA
90503-6709
US

V. Phone/Fax

Practice location:
  • Phone: 310-792-3914
  • Fax: 310-792-3621
Mailing address:
  • Phone: 310-792-3914
  • Fax: 310-792-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG72589
License Number StateCA

VIII. Authorized Official

Name: LOUIE H NGUYEN
Title or Position: PRESIDENT
Credential:
Phone: 310-792-3914