Healthcare Provider Details

I. General information

NPI: 1750667192
Provider Name (Legal Business Name): THERESA THANH NGOC NGUYEN, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5030 WESTMINSTER AVE
SANTA ANA CA
92703-1151
US

IV. Provider business mailing address

5030 WESTMINSTER AVE
SANTA ANA CA
92703-1151
US

V. Phone/Fax

Practice location:
  • Phone: 714-775-8090
  • Fax: 657-251-0494
Mailing address:
  • Phone: 714-775-8090
  • Fax: 657-251-0494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA61129
License Number StateCA

VIII. Authorized Official

Name: THERESA THANH NGOC NGUYEN
Title or Position: PHYSICIAN IN CHARGE
Credential: MD
Phone: 714-775-8090