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General NPI Number Information
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NPI Number | 1114201266
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Entity Type | Organization
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Legal Business Name | CHIDAO NGUYEN, D.O., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 9353 BOLSA AVE #E62
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City | WESTMINSTER
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State | CA
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Zip | 92683-5951
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Country | US
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Telephone | 909-786-5061
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Fax |
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Provider Business Mailing Address
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Address Line | 9353 BOLSA AVE #E62
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City | WESTMINSTER
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State | CA
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Zip | 92683-5951
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Country | US
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Telephone | 909-786-5061
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHIDAO NGUYEN
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Credential | D.O.
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Telephone | 909-786-5061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 20A10338
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License Number State | CA
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