=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528263175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THONG THANH NGUYEN DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2007
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39000 BOB HOPE DR
-----------------------------------------------------
City | RANCHO MIRAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92270-3221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-340-3911
-----------------------------------------------------
Fax | 760-773-1587
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39000 BOB HOPE DR
-----------------------------------------------------
City | RANCHO MIRAGE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92270-3221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-340-3911
-----------------------------------------------------
Fax | 760-773-1587
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0101X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology Physician
-----------------------------------------------------
License Number | BP2-0019923
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 3974
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | 20A11754
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------