Healthcare Provider Details

I. General information

NPI: 1386590958
Provider Name (Legal Business Name): JIMMY NGUYEN NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2688 N ANCHOR AVE
ORANGE CA
92865-2402
US

IV. Provider business mailing address

2688 N ANCHOR AVE
ORANGE CA
92865-2402
US

V. Phone/Fax

Practice location:
  • Phone: 714-781-9622
  • Fax:
Mailing address:
  • Phone: 714-781-9622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95034585
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: