Provider Demographics
NPI:1003545500
Name:NGUYEN, CASSIDY MINHHANH
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:MINHHANH
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4132 BELVEDERE ST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-2213
Mailing Address - Country:US
Mailing Address - Phone:949-923-9353
Mailing Address - Fax:
Practice Address - Street 1:4132 BELVEDERE ST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-2213
Practice Address - Country:US
Practice Address - Phone:949-923-9353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program