Healthcare Provider Details

I. General information

NPI: 1952981904
Provider Name (Legal Business Name): DANIEL QUAN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5570 OVERLAND AVE STE 101
SAN DIEGO CA
92123-1215
US

IV. Provider business mailing address

5570 OVERLAND AVE STE 101
SAN DIEGO CA
92123-1215
US

V. Phone/Fax

Practice location:
  • Phone: 858-694-2895
  • Fax:
Mailing address:
  • Phone: 858-694-2895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberA184531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: