Healthcare Provider Details

I. General information

NPI: 1619152170
Provider Name (Legal Business Name): TUTRAN NGUYEN DANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 12/22/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 TOPANGA CANYON BLVD
WOODLAND HILLS CA
91367-3623
US

IV. Provider business mailing address

8510 BALBOA BLVD STE 150
NORTHRIDGE CA
91325-5810
US

V. Phone/Fax

Practice location:
  • Phone: 818-888-7009
  • Fax:
Mailing address:
  • Phone: 818-637-2000
  • Fax: 818-654-3417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA18778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: