Healthcare Provider Details

I. General information

NPI: 1225217425
Provider Name (Legal Business Name): JOSEPH NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 04/06/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

1714 N BUSH ST
SANTA ANA CA
92706-2812
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5691
  • Fax:
Mailing address:
  • Phone: 562-396-4325
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA92171
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA91271
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA91271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: