Healthcare Provider Details

I. General information

NPI: 1134162621
Provider Name (Legal Business Name): KHANH NGUYEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N RENO ST
LOS ANGELES CA
90026-4656
US

IV. Provider business mailing address

1300 N VERMONT AVE SUITE 1002
LOS ANGELES CA
90027-6005
US

V. Phone/Fax

Practice location:
  • Phone: 213-380-7298
  • Fax: 213-385-1123
Mailing address:
  • Phone: 323-953-7341
  • Fax: 323-953-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA34291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: