Healthcare Provider Details

I. General information

NPI: 1184316689
Provider Name (Legal Business Name): HIEN MINH NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9702 BOLSA AVE SPC 124
WESTMINSTER CA
92683-6630
US

IV. Provider business mailing address

9702 BOLSA AVE SPC 124
WESTMINSTER CA
92683-6630
US

V. Phone/Fax

Practice location:
  • Phone: 714-261-6181
  • Fax:
Mailing address:
  • Phone: 714-261-6181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25462
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: