=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558598094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TUAN DUC NGUYEN DC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2009
-----------------------------------------------------
Last Update Date | 06/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13872 HARBOR BLVD # 1A
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-554-5304
-----------------------------------------------------
Fax | 714-554-6052
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13872 HARBOR BLVD # 1A
-----------------------------------------------------
City | GARDEN GROVE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92843-4000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-554-5304
-----------------------------------------------------
Fax | 714-554-6052
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | TUAN D. NGUYEN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 714-554-5304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 22941
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------