Healthcare Provider Details

I. General information

NPI: 1881480788
Provider Name (Legal Business Name): JOHNNY QUANG NGUYEN MSN, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N TUSTIN AVE STE 706
SANTA ANA CA
92705-3611
US

IV. Provider business mailing address

9231 OBSIDIAN DR
WESTMINSTER CA
92683-7345
US

V. Phone/Fax

Practice location:
  • Phone: 714-568-6600
  • Fax:
Mailing address:
  • Phone: 714-933-0636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP95038157
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95226627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: