Healthcare Provider Details

I. General information

NPI: 1760005581
Provider Name (Legal Business Name): JADE NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

6917 SEDAN AVE
WEST HILLS CA
91307-2508
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5187
  • Fax:
Mailing address:
  • Phone: 818-300-7853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number0000
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA190469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: