Healthcare Provider Details

I. General information

NPI: 1225792369
Provider Name (Legal Business Name): DIANA DOAN-NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2021
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

1150 BAKER ST
COSTA MESA CA
92626-4111
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-5705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: