Physician Compare National (NPI:1053668608)

HEALTHCARE PROVIDER: TAN BA NGUYEN M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1053668608
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7810204799
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20170721001538
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	NGUYEN
	Individual professional last name
Provider First Name	TAN
	Individual professional first name
Provider Middle Name	BA
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIVERSITY OF CALIFORNIA, GEFFEN SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	2012
	Individual professional's medical school graduation year
Primary Specialty	DIAGNOSTIC RADIOLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Organization Legal Name	CROWN VALLEY RADIOLOGISTS INC A PROFESSIONAL MEDICAL CORP
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	3476441965
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	5
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	27401 LOS ALTOS
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 150
	Group Practice or individual's line 2 address
City	MISSION VIEJO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	926918013
	Group Practice or individual's zip code (9 digits when available)
Phone Number	9493671010
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050329
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	CORONA REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050589
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	PLACENTIA LINDA HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	050758
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	MONTCLAIR HOSPITAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	050586
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	CHINO VALLEY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 4
Professional Accepts Medicare Assignment	Y