Healthcare Provider Details

I. General information

NPI: 1114121407
Provider Name (Legal Business Name): PHUC DANG NGUYEN M.D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 WESTMINSTER BLVD
WESTMINSTER CA
92683-4001
US

IV. Provider business mailing address

7901 WESTMINSTER BLVD
WESTMINSTER CA
92683-4001
US

V. Phone/Fax

Practice location:
  • Phone: 714-893-0882
  • Fax:
Mailing address:
  • Phone: 714-893-0882
  • Fax: 714-898-7052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA32505
License Number StateCA

VIII. Authorized Official

Name: DR. PHUC DANG NGUYEN
Title or Position: PRESIDENT
Credential: M.D
Phone: 714-893-0882