Healthcare Provider Details

I. General information

NPI: 1104214238
Provider Name (Legal Business Name): LAN N NGUYEN DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 12/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 CONVOY ST SUITE 201
SAN DIEGO CA
92111-3738
US

IV. Provider business mailing address

3750 CONVOY ST SUITE 201
SAN DIEGO CA
92111-3738
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-8301
  • Fax: 858-278-1708
Mailing address:
  • Phone: 858-278-8301
  • Fax: 858-278-1708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LAN NGOC NGUYEN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 619-372-6377