Healthcare Provider Details

I. General information

NPI: 1366530438
Provider Name (Legal Business Name): MRS. JENNY NGOC NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR STE 120
ORANGE CA
92868-3504
US

IV. Provider business mailing address

8645 E SUNNYWALK LN
ANAHEIM CA
92808-1688
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-3700
  • Fax:
Mailing address:
  • Phone: 714-345-0846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: