Healthcare Provider Details

I. General information

NPI: 1851832190
Provider Name (Legal Business Name): ANDREW MINH NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2017
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO STREET IPT C4E100
LOS ANGELES CA
90033
US

IV. Provider business mailing address

2051 MARENGO ST # C4E100
LOS ANGELES CA
90033-1352
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-7748
  • Fax:
Mailing address:
  • Phone: 323-409-7748
  • Fax: 323-441-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA157196
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA157196
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: