Healthcare Provider Details

I. General information

NPI: 1700104809
Provider Name (Legal Business Name): SUSAN K. NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 05/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E CHAPMAN AVE
ORANGE CA
92867-7775
US

IV. Provider business mailing address

12572 VALLEY VIEW ST
GARDEN GROVE CA
92845-2006
US

V. Phone/Fax

Practice location:
  • Phone: 714-221-2250
  • Fax: 714-221-2255
Mailing address:
  • Phone: 714-823-4400
  • Fax: 714-823-4404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT 36552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: