Healthcare Provider Details

I. General information

NPI: 1033965975
Provider Name (Legal Business Name): TREVOR-TRUNG NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TREVOR NGUYEN DO

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 S SUNSET AVE
WEST COVINA CA
91790-3940
US

IV. Provider business mailing address

1115 S SUNSET AVE
WEST COVINA CA
91790-3940
US

V. Phone/Fax

Practice location:
  • Phone: 626-962-4011
  • Fax:
Mailing address:
  • Phone: 626-962-4011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: