Healthcare Provider Details

I. General information

NPI: 1619171477
Provider Name (Legal Business Name): LOUIE HOANG NGUYEN MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2880 ATLANTIC AVE STE 180
LONG BEACH CA
90806-1736
US

IV. Provider business mailing address

PO BOX 4148
TORRANCE CA
90510-4148
US

V. Phone/Fax

Practice location:
  • Phone: 562-426-2606
  • Fax:
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: DR. LOUIE HOANG NGUYEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-792-3914