Healthcare Provider Details

I. General information

NPI: 1750382008
Provider Name (Legal Business Name): RANDALL L NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 LONG BEACH BLVD SUITE 300
LONG BEACH CA
90807-2011
US

IV. Provider business mailing address

4300 LONG BEACH BLVD SUITE 300
LONG BEACH CA
90807-2011
US

V. Phone/Fax

Practice location:
  • Phone: 562-984-7024
  • Fax: 562-428-7394
Mailing address:
  • Phone: 562-984-7024
  • Fax: 562-428-7394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA55189
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: