Healthcare Provider Details

I. General information

NPI: 1467711614
Provider Name (Legal Business Name): VU TRIEU NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 08/25/2023
Certification Date: 08/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

1106 E 45TH WAY
LONG BEACH CA
90807-1604
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-5437
  • Fax:
Mailing address:
  • Phone: 714-356-9312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number0101264986
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: