Healthcare Provider Details

I. General information

NPI: 1124041256
Provider Name (Legal Business Name): THU NGUYEN HOWELL M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6020 SEABLUFF DR SUITE 1
PLAYA VISTA CA
90094-2252
US

IV. Provider business mailing address

2222 NEILSON WAY SUITE 301
SANTA MONICA CA
90405-2281
US

V. Phone/Fax

Practice location:
  • Phone: 310-862-0400
  • Fax:
Mailing address:
  • Phone: 909-496-6944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA77900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: