Healthcare Provider Details

I. General information

NPI: 1144204231
Provider Name (Legal Business Name): SON C NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 10/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC BLVD LONG BEACH MEMORIAL M CTR
LONG BEACH CA
90806
US

IV. Provider business mailing address

2801 ATLANTIC AVE ATTN: RADIOLOGY DEPARTMENT
LONG BEACH CA
90806-1701
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-1550
  • Fax:
Mailing address:
  • Phone: 562-933-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberA76999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: