Healthcare Provider Details

I. General information

NPI: 1518385004
Provider Name (Legal Business Name): KHANG TRONG NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1617 WESTCLIFF DR STE 207
NEWPORT BEACH CA
92660-5526
US

IV. Provider business mailing address

1617 WESTCLIFF DR STE 207
NEWPORT BEACH CA
92660-5526
US

V. Phone/Fax

Practice location:
  • Phone: 949-400-7012
  • Fax: 949-603-3697
Mailing address:
  • Phone: 949-400-9012
  • Fax: 949-603-3697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD227252
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA179481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: