Healthcare Provider Details

I. General information

NPI: 1700822962
Provider Name (Legal Business Name): DUKE NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 05/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 N TUSTIN AVE
SANTA ANA CA
92705-3509
US

IV. Provider business mailing address

12 HUBBARD WAY
COTO DE CAZA CA
92679-5138
US

V. Phone/Fax

Practice location:
  • Phone: 714-835-6055
  • Fax: 714-835-3287
Mailing address:
  • Phone: 714-835-3709
  • Fax: 714-835-3287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberG83370
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG83370
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberG83370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: