Healthcare Provider Details

I. General information

NPI: 1639269160
Provider Name (Legal Business Name): HONG THU NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 04/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVE STE 615
LOS ANGELES CA
90015-3069
US

IV. Provider business mailing address

1400 S GRAND AVE STE 615
LOS ANGELES CA
90015-3069
US

V. Phone/Fax

Practice location:
  • Phone: 213-748-0110
  • Fax: 213-402-5466
Mailing address:
  • Phone: 213-748-0110
  • Fax: 213-402-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA90724
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA90724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: