Provider Demographics
NPI:1003893801
Name:NGUYEN, THERESA THANH NGOC (MD)
Entity Type:Individual
Prefix:
First Name:THERESA THANH
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:THANH
Other - Middle Name:NGOC
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15576 BROOKHURST ST STE B
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-7586
Mailing Address - Country:US
Mailing Address - Phone:714-775-8090
Mailing Address - Fax:714-775-2998
Practice Address - Street 1:15576 BROOKHURST ST STE B
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-7586
Practice Address - Country:US
Practice Address - Phone:714-775-8090
Practice Address - Fax:714-775-2998
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61129207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG70423Medicare UPIN
CAA61129AMedicare PIN