Healthcare Provider Details

I. General information

NPI: 1639565070
Provider Name (Legal Business Name): TAMMIE PHUONG NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

1136 N COLUMBUS AVE APT 213
GLENDALE CA
91202-2365
US

V. Phone/Fax

Practice location:
  • Phone: 916-698-0863
  • Fax:
Mailing address:
  • Phone: 916-698-0863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number134332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: