Healthcare Provider Details

I. General information

NPI: 1245855949
Provider Name (Legal Business Name): THIEN PHU NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 SKYPARK DR STE 200
TORRANCE CA
90505-4749
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-378-8900
  • Fax: 310-791-0789
Mailing address:
  • Phone: 310-301-8707
  • Fax: 310-791-0789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number20A20727
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: