Healthcare Provider Details

I. General information

NPI: 1114676277
Provider Name (Legal Business Name): LINCOLN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2022
Last Update Date: 03/23/2022
Certification Date: 03/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST
LOS ANGELES CA
90089-1001
US

IV. Provider business mailing address

13882 ARIZONA ST APT A
WESTMINSTER CA
92683-3993
US

V. Phone/Fax

Practice location:
  • Phone: 233-226-2622
  • Fax:
Mailing address:
  • Phone: 714-394-7460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: