Healthcare Provider Details

I. General information

NPI: 1407388010
Provider Name (Legal Business Name): NGAN THI KIM NGUYEN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2017
Last Update Date: 06/30/2023
Certification Date: 06/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE ONCOLOGY INSTITUTE OF HOPE AND INNOVATION 4646 BROCKTON AVE. #203
RIVERSIDE CA
92506
US

IV. Provider business mailing address

37 N CENTURY ST
MEMPHIS TN
38111-4624
US

V. Phone/Fax

Practice location:
  • Phone: 951-394-7028
  • Fax:
Mailing address:
  • Phone: 901-462-4805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number20A17494
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: