Provider Demographics
NPI:1043595085
Name:NGUYEN, TUAN ANH NICK (DPT)
Entity Type:Individual
Prefix:MR
First Name:TUAN ANH
Middle Name:NICK
Last Name:NGUYEN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12262 JANET ST
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-3822
Mailing Address - Country:US
Mailing Address - Phone:714-401-9659
Mailing Address - Fax:
Practice Address - Street 1:4482 BARRANCA PKWY
Practice Address - Street 2:SUITE 195
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-7701
Practice Address - Country:US
Practice Address - Phone:949-679-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT38204225100000X
PT382042251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT244540OtherBLUE SHIELD PIN
CAPT24454OtherPHYSICAL THERAPY BOARD OF CALIFORNIA
CAWPT24454AMedicaid
CAPT24454OtherPHYSICAL THERAPY BOARD OF CALIFORNIA