Healthcare Provider Details

I. General information

NPI: 1679223481
Provider Name (Legal Business Name): LONG LY NGUYEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23845 MCBEAN PKWY
VALENCIA CA
91355-2083
US

IV. Provider business mailing address

4411 E KINGS CANYON RD # 319
FRESNO CA
93702-3604
US

V. Phone/Fax

Practice location:
  • Phone: 661-200-2000
  • Fax:
Mailing address:
  • Phone: 559-600-2382
  • Fax:

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 StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A22045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: