Healthcare Provider Details

I. General information

NPI: 1366939043
Provider Name (Legal Business Name): MICHAEL HUNG NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 10/01/2023
Certification Date: 10/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

IV. Provider business mailing address

12223 HIGHLAND AVE STE 106-526
RANCHO CUCAMONGA CA
91739-2574
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-3000
  • Fax:
Mailing address:
  • Phone: 714-676-3880
  • Fax: 909-946-5221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number19061
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number19061
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: