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General NPI Number Information
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NPI Number | 1609269257
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Entity Type | Organization
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Legal Business Name | GARDEN GROVE FOOT AND ANKLE CLINIC
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 03/06/2015
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Provider Practice Location Address
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Address Line | 13310 EUCLID ST
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City | GARDEN GROVE
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State | CA
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Zip | 92843-2514
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Country | US
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Telephone | 714-638-2653
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Fax | 714-638-0103
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Provider Business Mailing Address
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Address Line | 13310 EUCLID ST
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City | GARDEN GROVE
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State | CA
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Zip | 92843-2514
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Country | US
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Telephone | 714-638-2653
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Fax | 714-638-0103
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Authorized Official
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Title or Position | CEO
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Name | DR. KELVIN HUY TANG NGUYEN
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Credential | DPM
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Telephone | 714-638-2653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4912
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License Number State | CA
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