Healthcare Provider Details

I. General information

NPI: 1922254432
Provider Name (Legal Business Name): MINH QUANG NGUYEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23456 HAWTHORNE BLVD STE 300
TORRANCE CA
90505-4716
US

IV. Provider business mailing address

23456 HAWTHORNE BLVD STE 300
TORRANCE CA
90505-4716
US

V. Phone/Fax

Practice location:
  • Phone: 310-539-2055
  • Fax: 310-539-0199
Mailing address:
  • Phone: 310-539-2055
  • Fax: 310-539-0199

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 State
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA108129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: