Healthcare Provider Details

I. General information

NPI: 1275446585
Provider Name (Legal Business Name): PETER AN THIEN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15782 LAS LUNAS ST
WESTMINSTER CA
92683-7024
US

IV. Provider business mailing address

15782 LAS LUNAS ST
WESTMINSTER CA
92683-7024
US

V. Phone/Fax

Practice location:
  • Phone: 714-722-7335
  • Fax:
Mailing address:
  • Phone: 714-722-7335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number49139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: