Healthcare Provider Details

I. General information

NPI: 1811733439
Provider Name (Legal Business Name): TRONG BAO NGUYEN FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CIVIC CENTER DR
SANTA ANA CA
92701-4521
US

IV. Provider business mailing address

5102 W 7TH ST
SANTA ANA CA
92703-2529
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-2555
  • Fax:
Mailing address:
  • Phone: 714-467-7629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95041661
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95305035
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: