Healthcare Provider Details

I. General information

NPI: 1659684223
Provider Name (Legal Business Name): HONG NGUYEN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2010
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:
  • Fax:
Mailing address:
  • Phone: 213-748-0110
  • Fax: 213-402-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA90724
License Number StateCA

VIII. Authorized Official

Name: DR. HONG THU NGUYEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 858-610-2262