Healthcare Provider Details

I. General information

NPI: 1457992927
Provider Name (Legal Business Name): HUONG T L NGUYEN MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4444 EL CAJON BLVD STE 6
SAN DIEGO CA
92115-4392
US

IV. Provider business mailing address

4444 EL CAJON BLVD STE 6
SAN DIEGO CA
92115-4392
US

V. Phone/Fax

Practice location:
  • Phone: 619-285-1522
  • Fax:
Mailing address:
  • Phone: 619-285-1522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: HUONG T L NGUYEN
Title or Position: PRESIDENT
Credential: MD
Phone: 619-285-1522