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General NPI Number Information
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NPI Number | 1831288406
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Entity Type | Individual
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Provider Name | RYAN QUOCHU NGUYEN DO
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Gender | Male
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 11/28/2012
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Provider Practice Location Address
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Address Line | 3200 LONG BEACH BOULEVARD
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City | LONG BEACH
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State | CA
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Zip | 90806-5062
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Country | US
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Telephone | 562-981-6865
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Fax | 562-595-6471
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Provider Business Mailing Address
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Address Line | 2360 PACIFIC AVE
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City | LONG BEACH
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State | CA
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Zip | 90806-3051
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Country | US
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Telephone | 562-981-6856
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Fax | 562-981-6851
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 20A7395
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License Number State | CA
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