Healthcare Provider Details

I. General information

NPI: 1679657449
Provider Name (Legal Business Name): JAMES Q NGUYEN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W WHITTIER BLVD SUITE B
MONTEBELLO CA
90640-4688
US

IV. Provider business mailing address

25050 AVENUE KEARNY STE 208
VALENCIA CA
91355-1257
US

V. Phone/Fax

Practice location:
  • Phone: 323-728-8010
  • Fax: 323-888-2342
Mailing address:
  • Phone: 661-430-0940
  • Fax: 661-295-0862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE4371
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: