Healthcare Provider Details

I. General information

NPI: 1134756596
Provider Name (Legal Business Name): RYAN HUY NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE STE 290
NEWPORT BEACH CA
92663-3664
US

IV. Provider business mailing address

510 SUPERIOR AVE STE 290
NEWPORT BEACH CA
92663-3664
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-7470
  • Fax: 949-764-7471
Mailing address:
  • Phone: 949-764-7470
  • Fax: 949-764-7471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA186078
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA186078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: