Provider Demographics
NPI:1053830679
Name:NGUYEN, MINH NGOC (DC, CPHT)
Entity Type:Individual
Prefix:DR
First Name:MINH
Middle Name:NGOC
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:DC, CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13811 LA VAUGHN DR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-2713
Mailing Address - Country:US
Mailing Address - Phone:714-396-5202
Mailing Address - Fax:
Practice Address - Street 1:13811 LA VAUGHN DR
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2713
Practice Address - Country:US
Practice Address - Phone:714-396-5202
Practice Address - Fax:714-396-5202
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34019111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty