=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306320197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIEN NGUYEN NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2018
-----------------------------------------------------
Last Update Date | 09/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8070 WESTMINSTER BLVD
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-3396
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-899-9898
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7921 HOPI RD
-----------------------------------------------------
City | STANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90680-3507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-291-4894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 95010059
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------