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General NPI Number Information
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NPI Number | 1689239584
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Entity Type | Individual
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Provider Name | NICHOLAS NGUYEN
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Gender | Male
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 09/20/2024
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Provider Practice Location Address
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Address Line | 999 N TUSTIN AVE STE 109
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City | SANTA ANA
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State | CA
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Zip | 92705-6501
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Country | US
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Telephone | 714-664-0045
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Fax | 714-664-0049
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Provider Business Mailing Address
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Address Line | 700 LAWRENCE EXPY
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City | SANTA CLARA
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State | CA
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Zip | 95051-5173
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | A177150
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License Number State | CA
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