=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629015656
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAI HOANG NGUYEN M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2006
-----------------------------------------------------
Last Update Date | 09/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14501 MAGNOLIA ST SUITE 109
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-5542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-903-8090
-----------------------------------------------------
Fax | 714-903-8191
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14501 MAGNOLIA ST SUITE 109
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92683-5542
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-903-8090
-----------------------------------------------------
Fax | 714-903-8191
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | A70950
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------