Provider Demographics
NPI:1023011384
Name:NGUYEN, AN DUY (MD)
Entity Type:Individual
Prefix:DR
First Name:AN
Middle Name:DUY
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1043 ELM AVENUE
Mailing Address - Street 2:STE 104
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3244
Mailing Address - Country:US
Mailing Address - Phone:562-590-0345
Mailing Address - Fax:562-437-8139
Practice Address - Street 1:19582 BEACH BLVD
Practice Address - Street 2:STE 212
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2996
Practice Address - Country:US
Practice Address - Phone:714-252-9415
Practice Address - Fax:714-963-8407
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2012-01-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA78574174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A785740Medicaid
CA00A785740Medicaid