Provider Demographics
NPI:1003999103
Name:NGUYEN, DANH TIEN (MD)
Entity Type:Individual
Prefix:
First Name:DANH
Middle Name:TIEN
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:TIEN
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1510 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2800
Mailing Address - Fax:310-445-2980
Practice Address - Street 1:4334 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2918
Practice Address - Country:US
Practice Address - Phone:951-682-7580
Practice Address - Fax:951-682-1580
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ612592085R0202X
CAA603822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARHL141511OtherDEPT OF HEALTH SERVICES
CA00A603820Medicaid
CA00A603820Medicaid
G84106Medicare UPIN
CA00A603820Medicaid