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General NPI Number Information
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NPI Number | 1306727037
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Entity Type | Individual
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Provider Name | JERRY NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 09/09/2025
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Last Update Date | 09/09/2025
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Provider Practice Location Address
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Address Line | 301 N LAKE AVE
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City | PASADENA
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State | CA
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Zip | 91101-4107
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Country | US
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Telephone | 626-568-9115
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Fax |
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Provider Business Mailing Address
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Address Line | 2702 MOZART ST
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City | LOS ANGELES
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State | CA
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Zip | 90031-3023
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Country | US
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Telephone | 323-475-0981
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 308919
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License Number State | CA
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