Healthcare Provider Details

I. General information

NPI: 1306945365
Provider Name (Legal Business Name): DUC NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2621 S BRISTOL ST
SANTA ANA CA
92704-5766
US

IV. Provider business mailing address

1177 ROADRUNNER WAY
SIMI VALLEY CA
93065-3159
US

V. Phone/Fax

Practice location:
  • Phone: 805-520-1577
  • Fax: 805-520-8091
Mailing address:
  • Phone: 805-520-1577
  • Fax: 805-520-8091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA53620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: