Provider Demographics
NPI:1003077256
Name:NGUYEN, VINH NGOC (MD)
Entity Type:Individual
Prefix:
First Name:VINH
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16061 MULLIEN CIRCLE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-1525
Mailing Address - Country:US
Mailing Address - Phone:714-642-6548
Mailing Address - Fax:
Practice Address - Street 1:3300 W COAST HWY STE B
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4007
Practice Address - Country:US
Practice Address - Phone:888-762-4127
Practice Address - Fax:714-571-5055
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ458682085R0202X
CAA1207882085R0202X
FLME1136302085R0202X
UT7675702-12052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ699777Medicaid
AZ699777Medicaid
CAGH175YMedicare PIN