Healthcare Provider Details

I. General information

NPI: 1770957458
Provider Name (Legal Business Name): MATTHEW NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 W LUGONIA AVE STE 120
REDLANDS CA
92374-9704
US

IV. Provider business mailing address

240 E HURON ST SUITE 1-200
CHICAGO IL
60611-2909
US

V. Phone/Fax

Practice location:
  • Phone: 714-308-1129
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number125074454
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberMD484763
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: