Healthcare Provider Details

I. General information

NPI: 1619618915
Provider Name (Legal Business Name): MR. KEVIN HIEU NGUYEN TABIRARA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KEVIN HIEU NGUYEN MD

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 04/26/2026
Certification Date: 04/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

3800 W CHAPMAN AVE STE 7300
ORANGE CA
92868-1612
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7890
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number187911
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: