Healthcare Provider Details

I. General information

NPI: 1902338478
Provider Name (Legal Business Name): HIEU TRUNG NGUYEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31700 TEMECULA PKWY
TEMECULA CA
92592-5896
US

IV. Provider business mailing address

42800 MORAGA RD APT 102
TEMECULA CA
92591-6705
US

V. Phone/Fax

Practice location:
  • Phone: 951-331-2200
  • Fax:
Mailing address:
  • Phone: 415-819-6478
  • Fax: 450-231-4052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD049375
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA172356
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: