Healthcare Provider Details

I. General information

NPI: 1336733245
Provider Name (Legal Business Name): MICHAEL LYNN NGUYEN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2021
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10171 NORTHAMPTON AVE
WESTMINSTER CA
92683-7558
US

IV. Provider business mailing address

PO BOX 2305
WESTMINSTER CA
92684-2305
US

V. Phone/Fax

Practice location:
  • Phone: 415-832-9159
  • Fax:
Mailing address:
  • Phone: 415-832-9159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95250910
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN255592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: