Provider Demographics
NPI:1063637080
Name:HUNG NGUYEN, DO, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HUNG NGUYEN, DO, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:HUNG
Authorized Official - Middle Name:M
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-296-6264
Mailing Address - Street 1:12762 ANNETTE CIR
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-6103
Mailing Address - Country:US
Mailing Address - Phone:714-296-6264
Mailing Address - Fax:714-621-0096
Practice Address - Street 1:11480 BROOKSHIRE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5021
Practice Address - Country:US
Practice Address - Phone:562-869-6400
Practice Address - Fax:714-621-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX85680Medicaid
CAW19134Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER #
W20A8568BMedicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
CA00AX85680Medicaid