Healthcare Provider Details

I. General information

NPI: 1457246167
Provider Name (Legal Business Name): AYWON-ANH NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 NEAR CT APT 606
WALNUT CREEK CA
94596-5615
US

IV. Provider business mailing address

PO BOX 231
LAFAYETTE CA
94549-0231
US

V. Phone/Fax

Practice location:
  • Phone: 714-717-1957
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: