Healthcare Provider Details

I. General information

NPI: 1972600906
Provider Name (Legal Business Name): KATIE NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 DEL AMO BLVD
TORRANCE CA
90503-1637
US

IV. Provider business mailing address

8211 SANDCOVE CIR UNIT 101
HUNTINGTON BEACH CA
92646-4456
US

V. Phone/Fax

Practice location:
  • Phone: 310-214-0811
  • Fax: 310-793-4665
Mailing address:
  • Phone: 310-993-5083
  • Fax: 310-374-0972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA70949
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: