Healthcare Provider Details

I. General information

NPI: 1689178568
Provider Name (Legal Business Name): JENNY NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11846 VENTURA BLVD STE 204
STUDIO CITY CA
91604-2620
US

IV. Provider business mailing address

4804 LAUREL CANYON BLVD # 374
VALLEY VILLAGE CA
91607-3717
US

V. Phone/Fax

Practice location:
  • Phone: 310-692-8998
  • Fax: 310-421-9771
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA174565
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number337513
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberDR.0077243
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0077243
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number337513
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA174565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: