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General NPI Number Information
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NPI Number | 1861587073
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Entity Type | Organization
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Legal Business Name | TAO TRUNG NGUYEN M.D., INC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 05/22/2020
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Provider Practice Location Address
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Address Line | 6043 ATLANTIC BLVD.
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City | MAYWOOD
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State | CA
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Zip | 90270-3118
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Country | US
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Telephone | 323-583-6516
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Fax | 323-583-0802
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Provider Business Mailing Address
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Address Line | P.O. BOX 3780
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City | LA HABRA
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State | CA
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Zip | 90632-3780
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Country | US
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Telephone | 323-583-6516
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Fax | 323-583-0802
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. TAO TRUNG NGUYEN
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Credential | M.D
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Telephone | 323-583-6516
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 00A444561
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License Number State | CA
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