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General NPI Number Information
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NPI Number | 1104502814
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Entity Type | Individual
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Provider Name | ANLANH-JENNIFER NGUYEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/26/2023
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 901 SAN BERNARDINO RD STE 102
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City | UPLAND
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State | CA
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Zip | 91786-4988
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Country | US
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Telephone | 909-579-6721
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Fax | 909-579-6737
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Provider Business Mailing Address
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Address Line | 27B LOS COYOTES DR
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City | POMONA
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State | CA
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Zip | 91766-4711
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Country | US
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Telephone | 909-538-9052
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA65643
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License Number State | CA
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