Healthcare Provider Details

I. General information

NPI: 1871809756
Provider Name (Legal Business Name): MR. HOANG NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 12/13/2022
Certification Date: 12/13/2022
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

PO BOX 311
SANTA ANA CA
92702-0311
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-3700
  • Fax:
Mailing address:
  • Phone: 714-414-8982
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number112261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: