Provider Demographics
NPI:1043584089
Name:NGUYEN, SILVERTON (PT)
Entity Type:Individual
Prefix:MR
First Name:SILVERTON
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEWPORT CENTER DR
Mailing Address - Street 2:213
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7501
Mailing Address - Country:US
Mailing Address - Phone:949-644-1322
Mailing Address - Fax:949-644-0316
Practice Address - Street 1:2888 LONG BEACH BLVD
Practice Address - Street 2:#405
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1530
Practice Address - Country:US
Practice Address - Phone:562-595-4489
Practice Address - Fax:562-595-4063
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38773225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGD444YMedicare PIN