Healthcare Provider Details

I. General information

NPI: 1477729549
Provider Name (Legal Business Name): THUY NGOC NGUYEN N.P, C.N.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCLA BRAIN RESEARCH INSTITUTE 695 CHARLES YOUNG DRIVE SOUTH BOX 951761
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

476 LANDFAIR AVENUE #104
LOS ANGELES CA
90024
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-2621
  • Fax: 310-825-9385
Mailing address:
  • Phone: 310-267-2621
  • Fax: 310-825-9385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number17795
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number2813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: