Healthcare Provider Details

I. General information

NPI: 1316017353
Provider Name (Legal Business Name): DAVID HUU NGUYEN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9246 VALLEY BLVD SUITE A
ROSEMEAD CA
91770-1922
US

IV. Provider business mailing address

9246 VALLEY BLVD SUITE A
ROSEMEAD CA
91770-1922
US

V. Phone/Fax

Practice location:
  • Phone: 626-641-2119
  • Fax: 626-571-7732
Mailing address:
  • Phone: 626-641-2119
  • Fax: 626-517-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A6867
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A6867
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: