Healthcare Provider Details

I. General information

NPI: 1265282149
Provider Name (Legal Business Name): DIEM-KHANH VICTORIA NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 07/29/2025
Certification Date: 07/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N STATE ST CLINIC TOWER, SUITE A7D
LOS ANGELES CA
90033-1029
US

IV. Provider business mailing address

1200 N STATE ST CLINIC TOWER, SUITE A7D
LOS ANGELES CA
90033-1029
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-5555
  • Fax:
Mailing address:
  • Phone: 323-409-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number15238
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: