Healthcare Provider Details

I. General information

NPI: 1760005581
Provider Name (Legal Business Name): JADE KHANHNGOC NGUYEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12462 PUTNAM ST STE 500
WHITTIER CA
90602-1049
US

IV. Provider business mailing address

6917 SEDAN AVE
WEST HILLS CA
91307-2508
US

V. Phone/Fax

Practice location:
  • Phone: 562-789-5449
  • Fax:
Mailing address:
  • Phone: 818-300-7853
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA190469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: