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General NPI Number Information
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NPI Number | 1003635277
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Entity Type | Individual
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Provider Name | TAYLOR THANH-TAM NGUYEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/07/2024
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Last Update Date | 10/07/2024
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Provider Practice Location Address
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Address Line | 7595 WESTMINSTER BLVD
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City | WESTMINSTER
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State | CA
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Zip | 92683-3919
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Country | US
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Telephone | 714-622-5482
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Fax |
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Provider Business Mailing Address
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Address Line | 17260 SANTA LUCIA ST
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-3116
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Country | US
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Telephone | 714-785-1999
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1206297
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License Number State |
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