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General NPI Number Information
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NPI Number | 1558503169
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Entity Type | Organization
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Legal Business Name | THUY T M NGUYEN M D INC
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Dates
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Enumeration Date | 03/27/2009
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 8891 CENTRAL AVE SUITE A
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City | MONTCLAIR
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State | CA
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Zip | 91763-1618
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Country | US
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Telephone | 909-297-3361
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Fax | 520-843-4181
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Provider Business Mailing Address
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Address Line | 5131 NELLIE CT
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-5132
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Country | US
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Telephone | 213-841-4181
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Fax | 520-843-4181
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Authorized Official
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Title or Position | CEO
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Name | THUY VO
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Credential | M.D.
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Telephone | 213-841-4181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 75293
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License Number State | CA
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