Healthcare Provider Details

I. General information

NPI: 1700304664
Provider Name (Legal Business Name): EDWARD NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2017
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

1805 VINE ST APT C
ALHAMBRA CA
91801-6601
US

V. Phone/Fax

Practice location:
  • Phone: 323-209-1000
  • Fax:
Mailing address:
  • Phone: 408-712-0710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101289366
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA181390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: