Healthcare Provider Details

I. General information

NPI: 1568756468
Provider Name (Legal Business Name): CYNTHIA VAN NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2011
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 S FAIR OAKS AVE
PASADENA CA
91105-2625
US

IV. Provider business mailing address

909 S FAIR OAKS AVE
PASADENA CA
91105-2625
US

V. Phone/Fax

Practice location:
  • Phone: 626-389-9300
  • Fax: 626-389-9336
Mailing address:
  • Phone: 626-389-9300
  • Fax: 626-389-9336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberA151630
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number151630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: