Healthcare Provider Details

I. General information

NPI: 1063145688
Provider Name (Legal Business Name): MINH HUU QUANG NGUYEN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 12/14/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SUPERIOR AVE STE 315
NEWPORT BEACH CA
92663-3641
US

IV. Provider business mailing address

1501 SUPERIOR AVE STE 315
NEWPORT BEACH CA
92663-3641
US

V. Phone/Fax

Practice location:
  • Phone: 949-520-7970
  • Fax: 949-942-1180
Mailing address:
  • Phone: 949-520-7970
  • Fax: 949-942-1180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT35133
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: